Healthcare Provider Details

I. General information

NPI: 1669895892
Provider Name (Legal Business Name): ROYAL GARDENS OF ST. CLOUD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4511 NEPTUNE RD
SAINT CLOUD FL
34769-6738
US

IV. Provider business mailing address

4511 NEPTUNE RD
SAINT CLOUD FL
34769-6738
US

V. Phone/Fax

Practice location:
  • Phone: 407-892-2290
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberAL5555
License Number StateFL

VIII. Authorized Official

Name: BRENDA PABELLANO
Title or Position: ADMINISTRATOR
Credential:
Phone: 407-892-2290