Organization
ULTIMATE DREAM HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAIYONNA BLACKMON LPN (OWNER)
(314) 410-9117
Entity
Organization
Contact information
Practice address
1409 WASHINGTON AVE STE 408, SAINT LOUIS, MO 63103-1917
(314) 410-9117
Mailing address
1409 WASHINGTON AVE STE 408, SAINT LOUIS, MO 63103-1917
(314) 410-9117
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
—
—
374U00000X
Home Health Aide
—
—
Other
Enumeration date
09/10/2025
Last updated
09/10/2025
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