Provider Demographics
NPI:1477909406
Name:DREAMS AND VISION, LLC- CADES COVE
Entity type:Organization
Organization Name:DREAMS AND VISION, LLC- CADES COVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-281-7261
Mailing Address - Street 1:5736 N TRYON ST STE 130
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-6898
Mailing Address - Country:US
Mailing Address - Phone:704-206-1255
Mailing Address - Fax:704-910-4188
Practice Address - Street 1:4429 CADES COVE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4586
Practice Address - Country:US
Practice Address - Phone:704-206-1255
Practice Address - Fax:704-910-4188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603885Medicaid