Provider Demographics
NPI:1164800876
Name:DREAM PROVIDER CARE SERVICES OF LOUISIANA INC
Entity Type:Organization
Organization Name:DREAM PROVIDER CARE SERVICES OF LOUISIANA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRISTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-751-2409
Mailing Address - Street 1:5215 ESSEN LN STE 5
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3563
Mailing Address - Country:US
Mailing Address - Phone:225-751-2409
Mailing Address - Fax:225-751-2466
Practice Address - Street 1:140 ASPEN SQ STE B
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-5323
Practice Address - Country:US
Practice Address - Phone:225-751-2409
Practice Address - Fax:225-751-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15410253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1722022Medicaid