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General NPI Number Information
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NPI Number | 1851858963
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Entity Type | Organization
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Legal Business Name | REAL HOLDINGS LLC
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Dates
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Enumeration Date | 02/25/2019
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Last Update Date | 02/25/2019
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Provider Practice Location Address
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Address Line | 3400 S 5TH W
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City | IDAHO FALLS
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State | ID
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Zip | 83402-7309
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Country | US
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Telephone | 208-357-3323
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Fax | 208-357-3302
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Provider Business Mailing Address
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Address Line | 3767 PROFESSIONAL WAY
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City | IDAHO FALLS
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State | ID
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Zip | 83402-7315
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Country | US
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Telephone | 208-357-3323
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Fax | 208-357-3302
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Authorized Official
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Title or Position | OPERATING OWNER
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Name | MICHAEL BLANE ROBBINS
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Credential |
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Telephone | 208-357-3323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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