Provider Demographics
NPI:1821281486
Name:DAYBREAK ON JAMES
Entity Type:Organization
Organization Name:DAYBREAK ON JAMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-413-3688
Mailing Address - Street 1:700 E BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-2201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2806
Practice Address - Country:US
Practice Address - Phone:315-474-1478
Practice Address - Fax:315-498-4409
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LORETTO HEALTH & REHABILITATION CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00582554Medicaid