Provider Demographics
NPI:1083315352
Name:DREAMU, LLC
Entity Type:Organization
Organization Name:DREAMU, LLC
Other - Org Name:DREAMU KIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO/APRN
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:330-646-7667
Mailing Address - Street 1:850 EUCLID AVENUE STE 819
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-3315
Mailing Address - Country:US
Mailing Address - Phone:330-646-7677
Mailing Address - Fax:833-471-6161
Practice Address - Street 1:850 EUCLID AVENUE STE 819
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-3315
Practice Address - Country:US
Practice Address - Phone:330-646-7677
Practice Address - Fax:833-471-6161
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DREAMU, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-14
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0014822Medicaid