Healthcare Provider Details

I. General information

NPI: 1306562707
Provider Name (Legal Business Name): THE DREAM CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 01/28/2023
Certification Date: 01/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 BELLEVUE AVE
LOS ANGELES CA
90026-4017
US

IV. Provider business mailing address

2301 BELLEVUE AVE
LOS ANGELES CA
90026-4017
US

V. Phone/Fax

Practice location:
  • Phone: 213-273-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: RICHARD JOHNSON
Title or Position: GRANTS MANAGER
Credential:
Phone: 915-263-0683