MEDICARE: A NEW DAWN MENTAL HEALTH INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1386000388	OTHER	MN	NPI TYPE 1

General Provider Information

NPI Number	:	1912594185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A NEW DAWN MENTAL HEALTH INC

Provider Business Mailing Address
First Line	:	38780 8TH AVE
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-6696
Country	:	US
Telephone Number	:	763-227-7223
Fax Number	:	651-317-6332

Provider Business Practice Location Address
First Line	:	38780 8TH AVE
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-6696
Country	:	US
Telephone Number	:	763-227-7223
Fax Number	:	651-317-6332

Authorized Official
Title or Position	:	OWNER
Name	:	DAWN RENEE BORER
Credential	:	MA
Telephone Number	:	763-227-7223

Provider Enumeration Date	:	12/22/2020
Last Update Date	:	12/22/2020

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