Provider Demographics
NPI:1578887097
Name:REAL LIFE HEALTHCARE, LLC
Entity Type:Organization
Organization Name:REAL LIFE HEALTHCARE, LLC
Other - Org Name:HEART OF TEXAS HOSPICE - THIRD COAST, LP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLLARHIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-679-3484
Mailing Address - Street 1:18568 FORTY SIX PKWY
Mailing Address - Street 2:SUITE 3001A
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-6879
Mailing Address - Country:US
Mailing Address - Phone:830-730-7711
Mailing Address - Fax:
Practice Address - Street 1:2688 CALDER ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1917
Practice Address - Country:US
Practice Address - Phone:409-832-3311
Practice Address - Fax:409-832-3312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001019124Medicaid
TX001019124Medicaid