Provider Demographics
NPI:1790058568
Name:A DAWN HOME LLC
Entity Type:Organization
Organization Name:A DAWN HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:410-905-3654
Mailing Address - Street 1:4994 BEAVERBROOK RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1408
Mailing Address - Country:US
Mailing Address - Phone:410-905-3654
Mailing Address - Fax:
Practice Address - Street 1:4994 BEAVERBROOK RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-1408
Practice Address - Country:US
Practice Address - Phone:410-905-3654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13AL0232-C310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5689505100OtherMARYLAND DEPARTMENT OF AGING MEDICAL CARE PROGRAM