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General NPI Number Information
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NPI Number | 1386508471
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Entity Type | Organization
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Legal Business Name | ROSEATE DAWN NEW BEGINNINGS INCORPORATED
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Dates
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Enumeration Date | 12/12/2025
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 4126 WEST 87TH STREET
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City | HOMETOWN
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State | IL
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Zip | 60456
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Country | US
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Telephone | 312-498-7177
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Fax | 773-498-7177
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Provider Business Mailing Address
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Address Line | 5030 N MARINE DR APT 806
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City | CHICAGO
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State | IL
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Zip | 60640-3372
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Country | US
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Telephone | 773-597-7698
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Fax | 773-597-7698
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Authorized Official
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Title or Position | COMPLIANCE OFFICER
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Name | MR. MARVIN D COKLOW
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Credential |
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Telephone | 773-597-7698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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