Provider Demographics
NPI:1598235277
Name:LIVE THE DREAM CENTER, INC
Entity Type:Organization
Organization Name:LIVE THE DREAM CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PASTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:CLERGY
Authorized Official - Phone:615-674-4326
Mailing Address - Street 1:3343 SYCAMORE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:TN
Mailing Address - Zip Code:37190-5025
Mailing Address - Country:US
Mailing Address - Phone:615-674-4326
Mailing Address - Fax:
Practice Address - Street 1:3343 SYCAMORE CREEK RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-5025
Practice Address - Country:US
Practice Address - Phone:615-674-4326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit