Basic Information
| Provider Information | |||||||||
| NPI: | 1457686230 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DAWN, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DAWN FARM | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6633 STONY CREEK RD | ||||||||
| Address2: | |||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481976609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344858725 | ||||||||
| FaxNumber: | 7344856103 | ||||||||
| Practice Location | |||||||||
| Address1: | 6633 STONY CREEK RD | ||||||||
| Address2: | |||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481976609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344858725 | ||||||||
| FaxNumber: | 7344856103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2009 | ||||||||
| LastUpdateDate: | 12/06/2013 | ||||||||
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| AuthorizedOfficialLastName: | BALMER | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7344858725 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 810012 | MI | N | Agencies | Community/Behavioral Health | 324500000X | 810012 | MI | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.