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General NPI Number Information
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NPI Number | 1750075024
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Entity Type | Organization
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Legal Business Name | DREAM 4 DEJAH, LLC
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Dates
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Enumeration Date | 06/08/2023
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 535 E ADAMS ST APT 4
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City | LONG BEACH
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State | CA
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Zip | 90805-2353
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Country | US
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Telephone | 888-226-1333
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Fax | 562-286-8296
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Provider Business Mailing Address
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Address Line | 6187 ATLANTIC AVE #2059
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City | LONG BEACH
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State | CA
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Zip | 90805-2922
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Country | US
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Telephone | 888-226-1333
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Fax | 562-286-8296
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Authorized Official
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Title or Position | ALCOHOL AND DRUG COUNSELOR
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Name | MS. SITUMBA STANSBERRY
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Credential | CADC II
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Telephone | 888-226-1333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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