Provider Demographics
NPI:1407486764
Name:ELIJAHS DREAM COMPASSIONATE CARE
Entity Type:Organization
Organization Name:ELIJAHS DREAM COMPASSIONATE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KINSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:423-313-1865
Mailing Address - Street 1:2010 FOXFIRE RD NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37323-5739
Mailing Address - Country:US
Mailing Address - Phone:423-313-1865
Mailing Address - Fax:
Practice Address - Street 1:134 CREEKSIDE DR STE 1
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:TN
Practice Address - Zip Code:37361-3653
Practice Address - Country:US
Practice Address - Phone:423-299-9491
Practice Address - Fax:423-299-9365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care