Basic Information
| Provider Information | |||||||||
| NPI: | 1770129884 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | REAL HEALTHY HABITS LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | REAL HEALTHY HABITS | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 108 BRICKSTONE PL | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357563498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565276040 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7027 OLD MADISON PIKE NW STE 108 | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358062369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565306040 | ||||||||
| FaxNumber: | 8448780475 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2019 | ||||||||
| LastUpdateDate: | 04/02/2022 | ||||||||
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| AuthorizedOfficialLastName: | GARCIA | ||||||||
| AuthorizedOfficialFirstName: | TREVA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2565276040 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RDN | ||||||||
| NPICertificationDate: | 04/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.