Healthcare Provider Details

I. General information

NPI: 1376889055
Provider Name (Legal Business Name): ROYAL TREATMENT HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2012
Last Update Date: 01/20/2021
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4671 S US HIGHWAY 25E
BIMBLE KY
40915-0000
US

IV. Provider business mailing address

4671 S US HIGHWAY 25E
BIMBLE KY
40915-0000
US

V. Phone/Fax

Practice location:
  • Phone: 606-546-2598
  • Fax:
Mailing address:
  • Phone: 606-546-2598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number900288
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3002774
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BARBARA BARGO
Title or Position: PROVIDER
Credential: ARNP
Phone: 606-546-2598