=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386342913
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DREAMS OF MY GRANDPARENTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2023
-----------------------------------------------------
Last Update Date | 02/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3800 FLAGSHIP WAY PORTSMOUTH, VA 23703
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23703-1309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-397-4876
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3590 TOWNE POINT RD UNIT 6532
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23703-1309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-397-4876
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PAULA FILLMORE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 866-397-4876
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------