Provider Demographics
NPI:1386342913
Name:DREAMS OF MY GRANDPARENTS LLC
Entity type:Organization
Organization Name:DREAMS OF MY GRANDPARENTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:FILLMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-397-4876
Mailing Address - Street 1:3590 TOWNE POINT RD UNIT 6532
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-1309
Mailing Address - Country:US
Mailing Address - Phone:866-397-4876
Mailing Address - Fax:
Practice Address - Street 1:3800 FLAGSHIP WAY PORTSMOUTH, VA 23703
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-1309
Practice Address - Country:US
Practice Address - Phone:866-397-4876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)