Provider Demographics
NPI:1144406851
Name:DREAM PROVIDER CARE SERVICES
Entity Type:Organization
Organization Name:DREAM PROVIDER CARE SERVICES
Other - Org Name:DREAM PROVIDER CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WENDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-946-0585
Mailing Address - Street 1:1255 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3405
Mailing Address - Country:US
Mailing Address - Phone:252-946-0580
Mailing Address - Fax:
Practice Address - Street 1:1255 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3405
Practice Address - Country:US
Practice Address - Phone:252-946-0585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301273HMedicaid
NC8301273GMedicaid