Provider Demographics
NPI:1891331237
Name:DAYBREAK INCORPORATED
Entity Type:Organization
Organization Name:DAYBREAK INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT EXECUTIVE DIRECTOR
Authorized Official - Prefix:
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:907-746-6019
Mailing Address - Street 1:550 S ALASKA ST STE 202
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6372
Mailing Address - Country:US
Mailing Address - Phone:907-746-6019
Mailing Address - Fax:907-745-7565
Practice Address - Street 1:121 W FIREWEED LN STE 175
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2035
Practice Address - Country:US
Practice Address - Phone:888-933-0102
Practice Address - Fax:907-274-2826
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAYBREAK, INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1811042872Medicaid