Provider Demographics
NPI:1073222329
Name:REAL LIFE HEALTHCARE SYSTEMS CORPORATION
Entity Type:Organization
Organization Name:REAL LIFE HEALTHCARE SYSTEMS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/AO
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:AYUK
Authorized Official - Last Name:ETCHU
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:667-367-3061
Mailing Address - Street 1:8128 PLEASANT PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21286-8324
Mailing Address - Country:US
Mailing Address - Phone:667-367-3061
Mailing Address - Fax:
Practice Address - Street 1:8128 PLEASANT PLAINS RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286-8324
Practice Address - Country:US
Practice Address - Phone:667-367-3061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care