MEDICARE: A NEW DAWN CONSULTING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1568953347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A NEW DAWN CONSULTING, LLC

Provider Business Mailing Address
First Line	:	6241 MAIN ST STE 105
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-6598
Country	:	US
Telephone Number	:	763-227-7223
Fax Number	:	763-271-2707

Provider Business Practice Location Address
First Line	:	6241 MAIN ST STE 105
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-6598
Country	:	US
Telephone Number	:	763-227-7223
Fax Number	:	763-271-2707

Authorized Official
Title or Position	:	OWNER
Name	:	DAWN BORER
Credential	:	LMFT
Telephone Number	:	763-227-7223

Provider Enumeration Date	:	05/28/2018
Last Update Date	:	05/28/2018

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