Provider Demographics
NPI:1336279488
Name:DREAMS COME TRUE INC
Entity Type:Organization
Organization Name:DREAMS COME TRUE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:MR
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEYADMINISTRATOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-979-6420
Mailing Address - Street 1:3242 SWANDALE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4404
Mailing Address - Country:US
Mailing Address - Phone:210-979-6420
Mailing Address - Fax:210-308-7411
Practice Address - Street 1:3242 SWANDALE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4404
Practice Address - Country:US
Practice Address - Phone:210-979-6420
Practice Address - Fax:210-308-7411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness