Provider Demographics
NPI:1518004555
Name:DREAM TEAM OF LA, INC.
Entity Type:Organization
Organization Name:DREAM TEAM OF LA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ORIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-208-4259
Mailing Address - Street 1:8324 PARC PL
Mailing Address - Street 2:STE. B
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-1646
Mailing Address - Country:US
Mailing Address - Phone:504-208-4259
Mailing Address - Fax:504-274-0083
Practice Address - Street 1:8324 PARC PL
Practice Address - Street 2:STE. B
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-1646
Practice Address - Country:US
Practice Address - Phone:504-208-4259
Practice Address - Fax:504-274-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 9929251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1171859Medicaid