MEDICARE: DREAMWORKS 2, LLC

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760719462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DREAMWORKS 2, LLC

Provider Business Mailing Address
First Line	:	PO BOX 51669
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27717-1669
Country	:	US
Telephone Number	:	919-226-3180
Fax Number	:	919-226-3183

Provider Business Practice Location Address
First Line	:	1802 MARTIN LUTHER KING PKWY
Second Line	:	SUITE 108
City	:	DURHAM
State	:	NC
Zip	:	27707-3586
Country	:	US
Telephone Number	:	919-226-3180
Fax Number	:	919-226-3183

Authorized Official
Title or Position	:	OWNER
Name	:	TAMARA CRAWFORD
Credential	:
Telephone Number	:	919-672-7501

Provider Enumeration Date	:	11/17/2009
Last Update Date	:	11/17/2009

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Directions to “DREAMWORKS 2, LLC ” Practice Location

Language	Start Address	Practice Location

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