Healthcare Provider Details

I. General information

NPI: 1538828116
Provider Name (Legal Business Name): REAL ONE ADVOCACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 ALYSSA LN UNIT 109
DAVENPORT FL
33837-3722
US

IV. Provider business mailing address

3020 ALYSSA LN UNIT 109
DAVENPORT FL
33837-3722
US

V. Phone/Fax

Practice location:
  • Phone: 863-605-5354
  • Fax:
Mailing address:
  • Phone: 863-605-5354
  • Fax:

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 Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. RAYMONDA SHEKENYA JOHNSON
Title or Position: OWNER
Credential: RN
Phone: 863-605-5354