Healthcare Provider Details

I. General information

NPI: 1427581941
Provider Name (Legal Business Name): ROYAL LIFE CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 W GURLEY ST
PRESCOTT AZ
86305-3624
US

IV. Provider business mailing address

661 S SWINTON AVE SUITE A
DELRAY BEACH FL
33444-3576
US

V. Phone/Fax

Practice location:
  • Phone: 877-732-6837
  • Fax: 800-871-3317
Mailing address:
  • Phone: 954-304-3047
  • Fax: 800-871-3317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberOTC8178
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberOTC8179
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberBH5136
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberBH5137
License Number StateAZ

VIII. Authorized Official

Name: MR. ERIC ANDREWS
Title or Position: DIRECTOR OF QUALITY ASSURANCE
Credential:
Phone: 928-379-3097