Provider Demographics
NPI:1316491905
Name:THE LODGE AT NEW DAWN, INC.
Entity type:Organization
Organization Name:THE LODGE AT NEW DAWN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSHBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-343-5521
Mailing Address - Street 1:3660 GREENTREE AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44706-4024
Mailing Address - Country:US
Mailing Address - Phone:330-484-5888
Mailing Address - Fax:330-484-5246
Practice Address - Street 1:3660 GREENTREE AVENUE, SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44706-4024
Practice Address - Country:US
Practice Address - Phone:330-484-5888
Practice Address - Fax:330-484-5246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility