MEDICARE: REAL LIFE HEALTHCARE SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	67-1655	OTHER		MEDICARE PROVIDER NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	013328	OTHER		STATE LICENSE

General Provider Information

NPI Number	:	1033434501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REAL LIFE HEALTHCARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 20595
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77720-0595
Country	:	US
Telephone Number	:	210-858-9138
Fax Number	:	210-568-4171

Provider Business Practice Location Address
First Line	:	6523 MOSS OAK DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4221
Country	:	US
Telephone Number	:	210-858-9138
Fax Number	:	210-568-4171

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	JANET R MONTAGNE
Credential	:
Telephone Number	:	409-201-9655

Provider Enumeration Date	:	03/28/2010
Last Update Date	:	02/29/2024

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Directions to “REAL LIFE HEALTHCARE SERVICES, LLC ” Practice Location

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