Provider Demographics
NPI:1760090062
Name:NEW DAWN TMS PSYCHIATRY
Entity Type:Organization
Organization Name:NEW DAWN TMS PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCILLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:314-497-0500
Mailing Address - Street 1:640 S SAN VINCENTE BLVD, STE. 210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4654
Mailing Address - Country:US
Mailing Address - Phone:909-378-8000
Mailing Address - Fax:855-212-4696
Practice Address - Street 1:640 S SAN VINCENTE BLVD, STE. 210
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:909-378-8000
Practice Address - Fax:855-212-4696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1770897357OtherNPI