Provider Demographics
NPI:1750601795
Name:DAYBREAK CANYON
Entity type:Organization
Organization Name:DAYBREAK CANYON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCARTHUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-312-4117
Mailing Address - Street 1:PO BOX 348
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83303-0348
Mailing Address - Country:US
Mailing Address - Phone:208-655-4111
Mailing Address - Fax:877-580-3806
Practice Address - Street 1:275 E 1600 N
Practice Address - Street 2:
Practice Address - City:RUPERT
Practice Address - State:ID
Practice Address - Zip Code:83350-9563
Practice Address - Country:US
Practice Address - Phone:208-312-4117
Practice Address - Fax:877-580-3806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID28990323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility