Healthcare Provider Details

I. General information

NPI: 1598816423
Provider Name (Legal Business Name): ROYALTON MANOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 PEACE BOULEVARD
ST JOSEPH MI
49085
US

IV. Provider business mailing address

288 PEACE BOULEVARD
ST JOSEPH MI
49085
US

V. Phone/Fax

Practice location:
  • Phone: 269-556-9050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MOHAMMAD ASHRAF QAZI
Title or Position: CEO
Credential:
Phone: 248-386-0300