Provider Demographics
NPI:1184918740
Name:BUILDING DREAMS LIFE ENHANCEMENT SERVICES, INC.
Entity type:Organization
Organization Name:BUILDING DREAMS LIFE ENHANCEMENT SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:LILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-695-2391
Mailing Address - Street 1:882 HAILEYS FERRY RD
Mailing Address - Street 2:P.O. BOX 313
Mailing Address - City:LILESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28091-6050
Mailing Address - Country:US
Mailing Address - Phone:704-695-2391
Mailing Address - Fax:704-848-4831
Practice Address - Street 1:882 HAILEYS FERRY RD
Practice Address - Street 2:882 HAILEYS FERRY ROAD
Practice Address - City:LILESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28091-6050
Practice Address - Country:US
Practice Address - Phone:704-695-2391
Practice Address - Fax:704-848-4831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========Medicaid