Provider Demographics
NPI:1437491842
Name:A DREAM HOME FOR DAD/MOM, LLC
Entity Type:Organization
Organization Name:A DREAM HOME FOR DAD/MOM, LLC
Other - Org Name:A DREAM HOME FOR YOU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:OLAJUWON
Authorized Official - Middle Name:
Authorized Official - Last Name:AKINOLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-791-3600
Mailing Address - Street 1:10925 ESTATE LN STE W214
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-2315
Mailing Address - Country:US
Mailing Address - Phone:214-791-3600
Mailing Address - Fax:
Practice Address - Street 1:10925 ESTATE LN STE W214
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-2315
Practice Address - Country:US
Practice Address - Phone:214-791-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-24
Last Update Date:2013-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization