Organization
THE DREAM HOUSE FOR MEDICALLY FRAGILE CHILDREN, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM MARKS (CHIEF PROGRAM OFFICER)
(770) 717-7410
Entity
Organization
Contact information
Practice address
4896 MILLER RD SW, LILBURN, GA 30047-5333
(770) 806-1621
(678) 990-9812
Mailing address
2092 SCENIC HWY N, SUITE B, SNELLVILLE, GA 30078-6188
(770) 717-7410
(770) 923-0659
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
067R0725
GA
251B00000X
Case Management Agency
CTCC001001
GA
251E00000X
Home Health Agency
067R0725
GA
251J00000X
Nursing Care Agency
Primary
067R0725
GA
251J00000X
Nursing Care Agency
CTCC001001
GA
253J00000X
Foster Care Agency
CTCC001001
GA
3140N1450X
Pediatric Skilled Nursing Facility
067R0725
GA
3140N1450X
Pediatric Skilled Nursing Facility
CTCC001001
GA
343800000X
Secured Medical Transport (VAN)
067R0725
GA
343900000X
Non-emergency Medical Transport (VAN)
CTCC001001
GA
385HR2065X
Child Physical Disabilities Respite Care
CTCC001001
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
513959537A
GEORGIA MEDICAID/PEACH CARE FOR KIDS
GA
Enumeration date
07/29/2010
Last updated
07/29/2010
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