MEDICARE: ROYAL TREATMENT HEALTH SYSTEMS, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366642233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL TREATMENT HEALTH SYSTEMS, LLC.

Provider Business Mailing Address
First Line	:	2450 LAWRENCEVILLE HWY
Second Line	:	SUITE 101
City	:	DECATUR
State	:	GA
Zip	:	30033-3268
Country	:	US
Telephone Number	:	770-609-6976
Fax Number	:	404-601-9622

Provider Business Practice Location Address
First Line	:	2450 LAWRENCEVILLE HWY
Second Line	:	SUITE 101
City	:	DECATUR
State	:	GA
Zip	:	30033-3268
Country	:	US
Telephone Number	:	770-609-6976
Fax Number	:	404-601-9622

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. GARYKE HART
Credential	:
Telephone Number	:	770-609-6976

Provider Enumeration Date	:	07/19/2007
Last Update Date	:	07/15/2015

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