=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437663861
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DREAM LAND HEALTHCARE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2017
-----------------------------------------------------
Last Update Date | 06/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3213 IH 30 STE 304
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75150-2695
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-264-4376
-----------------------------------------------------
Fax | 214-594-7679
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3213 IH 30 STE 304
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75150-2695
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-264-4376
-----------------------------------------------------
Fax | 214-594-7679
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | RITA AGU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 469-264-4376
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------