Provider Demographics
NPI:1447654561
Name:EXPERIENCE THE DREAM
Entity type:Organization
Organization Name:EXPERIENCE THE DREAM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:ESCHLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT
Authorized Official - Phone:435-632-6900
Mailing Address - Street 1:435 E TABERNACLE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2979
Mailing Address - Country:US
Mailing Address - Phone:888-688-1118
Mailing Address - Fax:
Practice Address - Street 1:435 E TABERNACLE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2979
Practice Address - Country:US
Practice Address - Phone:888-688-1118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care