Provider Demographics
NPI:1346342037
Name:PIECES OF A DREAM, INC
Entity Type:Organization
Organization Name:PIECES OF A DREAM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-532-6289
Mailing Address - Street 1:1923 GREY FALCON CIR SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-8609
Mailing Address - Country:US
Mailing Address - Phone:772-532-6289
Mailing Address - Fax:772-562-3018
Practice Address - Street 1:1923 GREY FALCON CIRCLE SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962-2612
Practice Address - Country:US
Practice Address - Phone:772-532-6289
Practice Address - Fax:772-675-1881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL687088198Medicaid
FL687088196Medicaid