Provider Demographics
NPI:1720842123
Name:NEW DAWN AFC HOME LLC
Entity Type:Organization
Organization Name:NEW DAWN AFC HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VALISA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-422-5711
Mailing Address - Street 1:PO BOX 942
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48311-0942
Mailing Address - Country:US
Mailing Address - Phone:313-422-5711
Mailing Address - Fax:
Practice Address - Street 1:16918 GRIGGS ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2880
Practice Address - Country:US
Practice Address - Phone:313-422-5711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home