Basic Information
| Provider Information | |||||||||
| NPI: | 1871912311 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAWN FARM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6633 STONY CREEK RD | ||||||||
| Address2: | |||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481976609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344858725 | ||||||||
| FaxNumber: | 7346690728 | ||||||||
| Practice Location | |||||||||
| Address1: | 502 W HURON ST | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481034208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346698265 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2014 | ||||||||
| LastUpdateDate: | 04/14/2014 | ||||||||
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| AuthorizedOfficialLastName: | BYBERG | ||||||||
| AuthorizedOfficialFirstName: | ANNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROGRAM COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 7346698265 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.