Provider Demographics
NPI:1093139602
Name:DREAMING BIG LLC
Entity Type:Organization
Organization Name:DREAMING BIG LLC
Other - Org Name:FIRSTLIGHT HOMECARE OF SOUTH ST. LOUIS & JEFFERSON COUNTIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEVELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-675-9957
Mailing Address - Street 1:6262 US HIGHWAY 61/67
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-2313
Mailing Address - Country:US
Mailing Address - Phone:314-675-9957
Mailing Address - Fax:
Practice Address - Street 1:6262 US HIGHWAY 61/67
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052-2313
Practice Address - Country:US
Practice Address - Phone:314-675-9957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health