Provider Demographics
NPI:1851858963
Name:REAL HOLDINGS LLC
Entity Type:Organization
Organization Name:REAL HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BLANE
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-357-3323
Mailing Address - Street 1:3767 PROFESSIONAL WAY
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-7315
Mailing Address - Country:US
Mailing Address - Phone:208-357-3323
Mailing Address - Fax:208-357-3302
Practice Address - Street 1:3400 S 5TH W
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-7309
Practice Address - Country:US
Practice Address - Phone:208-357-3323
Practice Address - Fax:208-357-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)