=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760333850
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAPA'S DREAM LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2026
-----------------------------------------------------
Last Update Date | 02/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5870 MOOREFIELD MEMORIAL HWY
-----------------------------------------------------
City | LIBERTY
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29657-9268
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-245-7191
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5870 MOOREFIELD MEMORIAL HWY
-----------------------------------------------------
City | LIBERTY
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29657-9268
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-245-7191
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MISS LATROYIE THOMPSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 864-245-7191
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------