Healthcare Provider Details

I. General information

NPI: 1386488427
Provider Name (Legal Business Name): DREAM COALITION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1754 MAIN STREET
INEZ KY
41224
US

IV. Provider business mailing address

PO BOX 2041
INEZ KY
41224-2041
US

V. Phone/Fax

Practice location:
  • Phone: 606-213-1652
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. RONALD ERIC MILLS
Title or Position: PRESIDENT
Credential:
Phone: 859-312-3742