Healthcare Provider Details

I. General information

NPI: 1821283573
Provider Name (Legal Business Name): ROYAL LIVING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SOUTH 9TH STREET
NEW BADEN IL
62265
US

IV. Provider business mailing address

200 SOUTH 9TH STREET
NEW BADEN IL
62265
US

V. Phone/Fax

Practice location:
  • Phone: 618-588-7295
  • Fax: 618-588-7290
Mailing address:
  • Phone: 618-588-7295
  • Fax: 618-588-7290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. DOLORES JEAN KREBS
Title or Position: ADMINISTRATOR
Credential:
Phone: 618-588-7295