Provider Demographics
NPI:1053783779
Name:SWEET DREAMS
Entity type:Organization
Organization Name:SWEET DREAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFFEBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-705-6346
Mailing Address - Street 1:3532 TRENTON WAY
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-6958
Mailing Address - Country:US
Mailing Address - Phone:916-705-6346
Mailing Address - Fax:
Practice Address - Street 1:3532 TRENTON WAY
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-6958
Practice Address - Country:US
Practice Address - Phone:916-705-6346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMEM-463489OtherAMERICAN ACADEMY OF PAIN MANAGEMENT
CA012345OtherSLEEP APNEA ASSOCIATION