Provider Demographics
NPI:1720419245
Name:DREAM HOME CARE AGENCY, LLC
Entity Type:Organization
Organization Name:DREAM HOME CARE AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CIERRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-758-1696
Mailing Address - Street 1:21250 HARPER AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2221
Mailing Address - Country:US
Mailing Address - Phone:586-944-2141
Mailing Address - Fax:586-944-2142
Practice Address - Street 1:21250 HARPER AVE STE 2
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2221
Practice Address - Country:US
Practice Address - Phone:313-758-1696
Practice Address - Fax:586-944-2142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7145342Medicaid