Healthcare Provider Details

I. General information

NPI: 1306827415
Provider Name (Legal Business Name): ROYAL CONVALESCENT HOSPITAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 CATTLE CALL DR
BRAWLEY CA
92227-3108
US

IV. Provider business mailing address

320 CATTLE CALL DR
BRAWLEY CA
92227-3108
US

V. Phone/Fax

Practice location:
  • Phone: 760-344-5431
  • Fax: 760-344-8240
Mailing address:
  • Phone: 760-344-5431
  • Fax: 760-344-8240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberZZT05893G
License Number StateCA

VIII. Authorized Official

Name: MR. FRED FRIEDMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 760-344-5431