Provider Demographics
NPI:1619367331
Name:DREAM SUPPORT, INC
Entity Type:Organization
Organization Name:DREAM SUPPORT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BANALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-810-2494
Mailing Address - Street 1:2701 N ROCKY POINT DR
Mailing Address - Street 2:SUITE 178
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5917
Mailing Address - Country:US
Mailing Address - Phone:813-961-2500
Mailing Address - Fax:
Practice Address - Street 1:2701 N ROCKY POINT DR
Practice Address - Street 2:SUITE 178
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5917
Practice Address - Country:US
Practice Address - Phone:813-961-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004636700Medicaid