Healthcare Provider Details

I. General information

NPI: 1265640585
Provider Name (Legal Business Name): ROYAL PALM MANOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7571 WYOMING ST
WESTMINSTER CA
92683-3922
US

IV. Provider business mailing address

7571 WYOMING ST
WESTMINSTER CA
92683-3922
US

V. Phone/Fax

Practice location:
  • Phone: 714-379-5101
  • Fax: 714-379-5104
Mailing address:
  • Phone: 714-379-5101
  • Fax: 714-379-5104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN SOOHYUN OH
Title or Position: SOCIAL WORKER
Credential: MSW
Phone: 714-379-5101