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General NPI Number Information
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NPI Number | 1730448168
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Entity Type | Organization
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Legal Business Name | A NEW DAWN SUPPORTED LIVING PROVIDER INC.
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Dates
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Enumeration Date | 05/04/2012
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Last Update Date | 05/04/2012
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Provider Practice Location Address
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Address Line | 7789 POINT VICENTE CT
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City | JACKSONVILLE
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State | FL
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Zip | 32256-7733
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Country | US
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Telephone | 904-737-4589
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Fax | 904-419-0202
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Provider Business Mailing Address
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Address Line | 7789 POINT VICENTE CT
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City | JACKSONVILLE
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State | FL
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Zip | 32256-7733
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Country | US
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Telephone | 904-737-4589
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Fax | 904-419-0202
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Authorized Official
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Title or Position | OWNER / CEO
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Name | LITHO D SIBLEY
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Credential |
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Telephone | 904-737-4589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 230557
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License Number State | FL
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