Healthcare Provider Details

I. General information

NPI: 1588660922
Provider Name (Legal Business Name): ROYAL OAK NURSING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37300 ROYAL OAK LN
DADE CITY FL
33525-5230
US

IV. Provider business mailing address

37300 ROYAL OAK LN
DADE CITY FL
33525-5230
US

V. Phone/Fax

Practice location:
  • Phone: 352-567-3122
  • Fax: 352-567-2250
Mailing address:
  • Phone: 352-567-3122
  • Fax: 352-567-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF14840962
License Number StateFL

VIII. Authorized Official

Name: MRS. ANITA E HOWARD
Title or Position: ADMINISTRATOR
Credential:
Phone: 352-567-3122