Provider Demographics
NPI:1417699240
Name:DREAM CLUBHOUSE INC
Entity Type:Organization
Organization Name:DREAM CLUBHOUSE INC
Other - Org Name:DREAM HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:TERRELL
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-550-8609
Mailing Address - Street 1:664 STRATFORD BLVD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-9647
Mailing Address - Country:US
Mailing Address - Phone:252-550-8609
Mailing Address - Fax:
Practice Address - Street 1:664 STRATFORD BLVD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-9647
Practice Address - Country:US
Practice Address - Phone:252-468-2973
Practice Address - Fax:855-717-1947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health