Provider Demographics
NPI:1376284950
Name:NEW DAWN FAMILY HEALING, LLC
Entity Type:Organization
Organization Name:NEW DAWN FAMILY HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:314-806-1026
Mailing Address - Street 1:711 OLD BALLAS RD STE 203
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7069
Mailing Address - Country:US
Mailing Address - Phone:314-806-1026
Mailing Address - Fax:
Practice Address - Street 1:711 OLD BALLAS RD STE 203
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7069
Practice Address - Country:US
Practice Address - Phone:314-806-1026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-06
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health