1023770153 NPI number — NEW DAWN WELLNESS AND MEDICAL CENTER

Table of content: (NPI 1023770153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023770153 NPI number — NEW DAWN WELLNESS AND MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW DAWN WELLNESS AND MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023770153
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2238 ALMOND CREEK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKSHIRE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77423-2983
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-449-8724
Provider Business Mailing Address Fax Number:
917-900-1547

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12000 RICHMOND AVE STE 215
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77082-2428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-449-8724
Provider Business Practice Location Address Fax Number:
917-900-1547
Provider Enumeration Date:
10/06/2021

Additional Information

Authorized Official

Authorized Official Last Name:
UKAZU
Authorized Official First Name:
ADANNA
Authorized Official Middle Name:
CYNTHIA
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
917-449-8724

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083A0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com