MEDICARE: DREAM HAVEN EXTENSIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1023945136
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DREAM HAVEN EXTENSIONS

Provider Business Mailing Address
First Line	:	4500 MERCANTILE PLAZA DR # 17147172
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-4225
Country	:	US
Telephone Number	:	214-635-6412
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 MERCANTILE PLAZA DR # 17147172
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-4225
Country	:	US
Telephone Number	:	214-635-6412
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DREAM HAVEN EXTENSIONS
Credential	:
Telephone Number	:	214-635-6412

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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Directions to “DREAM HAVEN EXTENSIONS ” Practice Location

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