Healthcare Provider Details

I. General information

NPI: 1851858963
Provider Name (Legal Business Name): REAL HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 S 5TH W
IDAHO FALLS ID
83402-7309
US

IV. Provider business mailing address

3767 PROFESSIONAL WAY
IDAHO FALLS ID
83402-7315
US

V. Phone/Fax

Practice location:
  • Phone: 208-357-3323
  • Fax: 208-357-3302
Mailing address:
  • Phone: 208-357-3323
  • Fax: 208-357-3302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BLANE ROBBINS
Title or Position: OPERATING OWNER
Credential:
Phone: 208-357-3323