Provider Demographics
NPI:1386508471
Name:ROSEATE DAWN NEW BEGINNINGS INCORPORATED
Entity type:Organization
Organization Name:ROSEATE DAWN NEW BEGINNINGS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:COKLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-597-7698
Mailing Address - Street 1:5030 N MARINE DR APT 806
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3372
Mailing Address - Country:US
Mailing Address - Phone:773-597-7698
Mailing Address - Fax:773-597-7698
Practice Address - Street 1:4126 WEST 87TH STREET
Practice Address - Street 2:
Practice Address - City:HOMETOWN
Practice Address - State:IL
Practice Address - Zip Code:60456
Practice Address - Country:US
Practice Address - Phone:312-498-7177
Practice Address - Fax:773-498-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-12
Last Update Date:2025-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder