Healthcare Provider Details

I. General information

NPI: 1194415802
Provider Name (Legal Business Name): A.E.S DREAMWORKS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 STAFFORD ST UNIT 101
MONROE NC
28110-3349
US

IV. Provider business mailing address

4904 CHRISTOPHER RUN DR
MONROE NC
28112-9506
US

V. Phone/Fax

Practice location:
  • Phone: 980-425-7917
  • Fax:
Mailing address:
  • Phone: 980-425-7917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: LASHAUN D ROSEBOROUGH-WHITE
Title or Position: OWNER
Credential:
Phone: 980-425-7917