Healthcare Provider Details

I. General information

NPI: 1841533122
Provider Name (Legal Business Name): ROYAL PALM RETIREMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 AARON ST
PORT CHARLOTTE FL
33952-6743
US

IV. Provider business mailing address

13770 58TH ST N SUITE 312
CLEARWATER FL
33760-3759
US

V. Phone/Fax

Practice location:
  • Phone: 941-627-6762
  • Fax: 941-627-9890
Mailing address:
  • Phone: 727-726-3980
  • Fax: 727-726-5345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL3915
License Number StateFL

VIII. Authorized Official

Name: MR. STEVEN PIAZZA
Title or Position: MANAGER
Credential:
Phone: 727-726-3980