Healthcare Provider Details

I. General information

NPI: 1215104096
Provider Name (Legal Business Name): ROYAL CARE A.C.L.F.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5081 DUNN RD
FORT PIERCE FL
34981-4942
US

IV. Provider business mailing address

5081 DUNN RD
FORT PIERCE FL
34981-4942
US

V. Phone/Fax

Practice location:
  • Phone: 772-464-0728
  • Fax:
Mailing address:
  • Phone: 772-464-0728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL7462
License Number StateFL

VIII. Authorized Official

Name: MRS. PAULA N RAUCHETT
Title or Position: OWNER/ADMINISTATOR
Credential:
Phone: 772-464-0728