Provider Demographics
NPI:1306592001
Name:LIVING THROUGH MY DREAMS, LLC
Entity type:Organization
Organization Name:LIVING THROUGH MY DREAMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:445-345-8166
Mailing Address - Street 1:407 QUAKER CT
Mailing Address - Street 2:
Mailing Address - City:LAWNSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08045-1039
Mailing Address - Country:US
Mailing Address - Phone:445-345-8166
Mailing Address - Fax:
Practice Address - Street 1:407 QUAKER CT
Practice Address - Street 2:
Practice Address - City:LAWNSIDE
Practice Address - State:NJ
Practice Address - Zip Code:08045-1039
Practice Address - Country:US
Practice Address - Phone:445-345-8166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization