Healthcare Provider Details

I. General information

NPI: 1770492191
Provider Name (Legal Business Name): REALISTIC LIFE HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8458 JAMES MADISON PKWY
KING GEORGE VA
22485-5115
US

IV. Provider business mailing address

5257 WEEMS DR
KING GEORGE VA
22485-2467
US

V. Phone/Fax

Practice location:
  • Phone: 443-534-2203
  • Fax:
Mailing address:
  • Phone: 443-534-2203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JANEENE E WOOD
Title or Position: ADMINISTRATOR
Credential:
Phone: 443-534-2203