Healthcare Provider Details

I. General information

NPI: 1508547761
Provider Name (Legal Business Name): ROYALTY HOMECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 S 4TH ST
LOUISVILLE KY
40208-1529
US

IV. Provider business mailing address

1628 ALBANY AVE
LOUISVILLE KY
40216-2614
US

V. Phone/Fax

Practice location:
  • Phone: 502-819-7550
  • Fax:
Mailing address:
  • Phone: 502-291-3620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. KHADIJA MOHAMED
Title or Position: OWNER
Credential:
Phone: 502-291-3620