Healthcare Provider Details

I. General information

NPI: 1538692025
Provider Name (Legal Business Name): DREAM HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 FILLMORE ST STE 114
DENVER CO
80206-1556
US

IV. Provider business mailing address

1633 FILLMORE ST SUITE 114
DENVER CO
80206
US

V. Phone/Fax

Practice location:
  • Phone: 720-383-7004
  • Fax:
Mailing address:
  • Phone: 720-383-7004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberNLC.0104495
License Number StateCO

VIII. Authorized Official

Name: MARIO JEROME FLOWERS
Title or Position: COUNSELOR
Credential: M.A
Phone: 720-585-1604