Provider Demographics
NPI:1447309380
Name:DREAMS '2' REALITY
Entity type:Organization
Organization Name:DREAMS '2' REALITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:QP
Authorized Official - Phone:704-968-6049
Mailing Address - Street 1:1551 MOORE DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5533
Mailing Address - Country:US
Mailing Address - Phone:704-864-8561
Mailing Address - Fax:704-947-0815
Practice Address - Street 1:1551 MOORE DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5533
Practice Address - Country:US
Practice Address - Phone:704-864-8561
Practice Address - Fax:704-947-0815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-036154322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC322D00000XMedicaid