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General NPI Number Information
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NPI Number | 1720842123
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Entity Type | Organization
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Legal Business Name | NEW DAWN AFC HOME LLC
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Dates
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Enumeration Date | 02/07/2024
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 16918 GRIGGS ST
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City | DETROIT
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State | MI
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Zip | 48221-2880
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Country | US
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Telephone | 313-422-5711
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 942
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City | STERLING HEIGHTS
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State | MI
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Zip | 48311-0942
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Country | US
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Telephone | 313-422-5711
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | VALISA D GLOVER
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Credential |
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Telephone | 313-422-5711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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