Healthcare Provider Details

I. General information

NPI: 1518668672
Provider Name (Legal Business Name): REAL LIFE HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 E SOUTH BLVD STE 238
MONTGOMERY AL
36116-2537
US

IV. Provider business mailing address

2600 E SOUTH BLVD STE 238
MONTGOMERY AL
36116-2537
US

V. Phone/Fax

Practice location:
  • Phone: 334-593-0498
  • Fax: 334-593-0312
Mailing address:
  • Phone: 334-593-0498
  • Fax: 334-593-0312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MELANIE RENAE HARVEY
Title or Position: OWNER
Credential:
Phone: 334-207-6120