1427111384 NPI number — DREAM MAKERS ASSISTED LIVING SERVICES, LLC..

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427111384 NPI number — DREAM MAKERS ASSISTED LIVING SERVICES, LLC..

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DREAM MAKERS ASSISTED LIVING SERVICES, LLC..
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:
1427111384
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 W HEMSTEAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27292-2696
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-300-0370
Provider Business Mailing Address Fax Number:
336-464-2225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4265 BROWNSBORO RD
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27106-3425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-300-0370
Provider Business Practice Location Address Fax Number:
336-464-2225
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TRANSOU
Authorized Official First Name:
STANLEY
Authorized Official Middle Name:
WINFRED
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
336-300-0370

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3409687 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com