Provider Demographics
NPI:1780264606
Name:A 2 DREAM LLC
Entity type:Organization
Organization Name:A 2 DREAM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHUKIA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:RELFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-293-3707
Mailing Address - Street 1:2295 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77703-5013
Mailing Address - Country:US
Mailing Address - Phone:409-293-3707
Mailing Address - Fax:
Practice Address - Street 1:2295 N 10TH ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77703-5013
Practice Address - Country:US
Practice Address - Phone:409-293-3707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-13
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4242901Medicaid