Provider Demographics
NPI:1730448168
Name:A NEW DAWN SUPPORTED LIVING PROVIDER INC.
Entity type:Organization
Organization Name:A NEW DAWN SUPPORTED LIVING PROVIDER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:
Authorized Official - First Name:LITHO
Authorized Official - Middle Name:D
Authorized Official - Last Name:SIBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-737-4589
Mailing Address - Street 1:7789 POINT VICENTE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7733
Mailing Address - Country:US
Mailing Address - Phone:904-737-4589
Mailing Address - Fax:904-419-0202
Practice Address - Street 1:7789 POINT VICENTE CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7733
Practice Address - Country:US
Practice Address - Phone:904-737-4589
Practice Address - Fax:904-419-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL230557253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care