Healthcare Provider Details

I. General information

NPI: 1760089874
Provider Name (Legal Business Name): ROYALTY ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5670 S EUCALYPTUS PL
CHANDLER AZ
85249-5224
US

IV. Provider business mailing address

619 W SPARROW PL
CHANDLER AZ
85286-7625
US

V. Phone/Fax

Practice location:
  • Phone: 480-912-1390
  • Fax:
Mailing address:
  • Phone: 480-228-8048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL IGWE
Title or Position: ADMINISTRATOR
Credential: MD
Phone: 480-228-8048