Provider Demographics
NPI:1154626141
Name:AMERICAN DREAM CONSTRUCTION, LLC
Entity type:Organization
Organization Name:AMERICAN DREAM CONSTRUCTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BRAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-357-8640
Mailing Address - Street 1:3381 E GODFREY DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-0320
Mailing Address - Country:US
Mailing Address - Phone:907-357-8640
Mailing Address - Fax:907-357-8630
Practice Address - Street 1:3381 E GODFREY DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-0320
Practice Address - Country:US
Practice Address - Phone:907-357-8640
Practice Address - Fax:907-357-8630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK34356251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKEM9194Medicaid