Healthcare Provider Details

I. General information

NPI: 1700925773
Provider Name (Legal Business Name): NEW DAWN ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19271 HIGHWAY 79
VALE SD
57788-0198
US

IV. Provider business mailing address

19271 HIGHWAY 79 P.O. BOX 198
VALE SD
57788-0198
US

V. Phone/Fax

Practice location:
  • Phone: 605-456-2968
  • Fax:
Mailing address:
  • Phone: 605-456-2968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number801
License Number StateSD

VIII. Authorized Official

Name: MR. ELDON R. GJERDE
Title or Position: DIRECTOR
Credential: CCDC II
Phone: 605-456-2968