Provider Demographics
NPI:1487057956
Name:DREAM 9D GROUP HOME LLC
Entity type:Organization
Organization Name:DREAM 9D GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DESTANEY
Authorized Official - Middle Name:LASHAY
Authorized Official - Last Name:STARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-919-1180
Mailing Address - Street 1:817 S JONES ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-4952
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:817 S JONES ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-4952
Practice Address - Country:US
Practice Address - Phone:804-919-1180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health