Provider Demographics
NPI:1699809384
Name:DAYBREAK TREATMENT CARE, LLC
Entity Type:Organization
Organization Name:DAYBREAK TREATMENT CARE, LLC
Other - Org Name:DAYBREAK TREATMENT CARE PROGRAM II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:I
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:JD, MBA
Authorized Official - Phone:732-245-8473
Mailing Address - Street 1:P.O. BOX 2136
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712
Mailing Address - Country:US
Mailing Address - Phone:732-922-0591
Mailing Address - Fax:732-922-0593
Practice Address - Street 1:258-68 PINEDGE DR.
Practice Address - Street 2:
Practice Address - City:WEST BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08091
Practice Address - Country:US
Practice Address - Phone:856-753-8111
Practice Address - Fax:856-753-3339
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAYBREAK TREATMENT CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-15
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10020-03-05261Q00000X
NJ10020-02-05261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0034771Medicaid