Healthcare Provider Details

I. General information

NPI: 1013885995
Provider Name (Legal Business Name): DREAM-LIVE-HOPE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E KELSO ST
INGLEWOOD CA
90301-2703
US

IV. Provider business mailing address

340 E KELSO ST
INGLEWOOD CA
90301-2703
US

V. Phone/Fax

Practice location:
  • Phone: 310-714-7234
  • Fax: 562-222-7924
Mailing address:
  • Phone: 310-714-7234
  • Fax: 562-222-7924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN CHRISTOPHER WATERS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 310-714-7234