Provider Demographics
NPI:1881035004
Name:NEW DAWN SERVICES
Entity Type:Organization
Organization Name:NEW DAWN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:POLLY
Authorized Official - Middle Name:TEEN
Authorized Official - Last Name:VICK
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-BC
Authorized Official - Phone:254-535-6020
Mailing Address - Street 1:2300 E RANCIER AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-3400
Mailing Address - Country:US
Mailing Address - Phone:254-200-2310
Mailing Address - Fax:254-200-2340
Practice Address - Street 1:2300 E RANCIER AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-3400
Practice Address - Country:US
Practice Address - Phone:254-200-2310
Practice Address - Fax:254-200-2340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
TX675722261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty