Provider Demographics
NPI:1962868448
Name:DAWN'S EARLY LIGHT LLC
Entity type:Organization
Organization Name:DAWN'S EARLY LIGHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PASCH
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:1262-948-0145
Mailing Address - Street 1:5316 73RD ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-3667
Mailing Address - Country:US
Mailing Address - Phone:262-948-0145
Mailing Address - Fax:
Practice Address - Street 1:5316 73RD ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-3667
Practice Address - Country:US
Practice Address - Phone:262-948-0145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WID055836374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty