Healthcare Provider Details

I. General information

NPI: 1710344361
Provider Name (Legal Business Name): ROYAL GARDENS HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2016
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2339 W VALLEY BLVD
ALHAMBRA CA
91803-1931
US

IV. Provider business mailing address

2339 W VALLEY BLVD
ALHAMBRA CA
91803-1931
US

V. Phone/Fax

Practice location:
  • Phone: 626-289-7809
  • Fax: 626-289-6475
Mailing address:
  • Phone: 626-289-7809
  • Fax: 626-289-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DOV E JACOBS
Title or Position: MANAGER
Credential:
Phone: 626-289-7809