Provider Demographics
NPI:1124209150
Name:BROTHERS & DREAMS CORPORATION
Entity type:Organization
Organization Name:BROTHERS & DREAMS CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OSWALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-878-2057
Mailing Address - Street 1:7592 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-1450
Mailing Address - Country:US
Mailing Address - Phone:772-878-2057
Mailing Address - Fax:772-878-2058
Practice Address - Street 1:7592 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-1450
Practice Address - Country:US
Practice Address - Phone:772-878-2057
Practice Address - Fax:772-878-2058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000284400Medicaid
FL1313469OtherAHCA
FL6260240001Medicare NSC