Healthcare Provider Details

I. General information

NPI: 1316491905
Provider Name (Legal Business Name): THE LODGE AT NEW DAWN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 GREENTREE AVENUE, SW
CANTON OH
44706-4024
US

IV. Provider business mailing address

3660 GREENTREE AVE SW
CANTON OH
44706-4024
US

V. Phone/Fax

Practice location:
  • Phone: 330-484-5888
  • Fax: 330-484-5246
Mailing address:
  • Phone: 330-484-5888
  • Fax: 330-484-5246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DANNIE HERSHBERGER
Title or Position: PRESIDENT
Credential:
Phone: 330-343-5521