MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 2408
Change Report (if Any):

Short Name: DAYBREAK

Long Name 1: DAYBREAK INC
Long Name 2:

Address 1: 605 SOUTH PATTERSON BLVD
Address 2:

City: DAYTON
Zip Code: 45402
County: MONT

Contact: LISA ORR
Title: CFO
Phone: 9373954600
FAX: 9373954610

Vendor: 2408

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/21/2011

File Produced: 19MAY2012