Provider Demographics
NPI:1013206630
Name:4 REAL GROUP, LLC
Entity Type:Organization
Organization Name:4 REAL GROUP, LLC
Other - Org Name:GREATER VISION FACILITIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-277-9814
Mailing Address - Street 1:PO BOX 2587
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75030-2587
Mailing Address - Country:US
Mailing Address - Phone:855-444-7325
Mailing Address - Fax:214-613-1583
Practice Address - Street 1:613 WORLEY GLEN AVE
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-3321
Practice Address - Country:US
Practice Address - Phone:214-277-9814
Practice Address - Fax:214-613-1583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities