MEDICARE: ACHIEVABLE DREAMS TODAY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency		NC
2	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number	:	1265679245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACHIEVABLE DREAMS TODAY, LLC

Provider Business Mailing Address
First Line	:	5421 OLD POOLE RD STE 107
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-3285
Country	:	US
Telephone Number	:	919-231-2261
Fax Number	:

Provider Business Practice Location Address
First Line	:	5421 OLD POOLE RD STE 107
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-3285
Country	:	US
Telephone Number	:	919-231-2261
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. GARLAND CAMPBELL
Credential	:	B.S.
Telephone Number	:	919-649-7714

Provider Enumeration Date	:	01/13/2009
Last Update Date	:	02/03/2010

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