Provider Demographics
NPI:1811042872
Name:DAYBREAK INCORPORATED
Entity Type:Organization
Organization Name:DAYBREAK INCORPORATED
Other - Org Name:DAYBREAK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:POLLY-BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BSW
Authorized Official - Phone:907-745-6012
Mailing Address - Street 1:263 S BONANZA ST
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6346
Mailing Address - Country:US
Mailing Address - Phone:907-746-6019
Mailing Address - Fax:907-745-7565
Practice Address - Street 1:263 S BONANZA ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6346
Practice Address - Country:US
Practice Address - Phone:907-746-6019
Practice Address - Fax:907-745-7565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH9284Medicaid