Healthcare Provider Details

I. General information

NPI: 1841420114
Provider Name (Legal Business Name): ROYALQUEEN HOMECARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7732 HAMPSHIRE AVE N
BROOKLYN PARK MN
55445-2707
US

IV. Provider business mailing address

7732 HAMPSHIRE AVE N
BROOKLYN PARK MN
55445-2707
US

V. Phone/Fax

Practice location:
  • Phone: 763-300-4615
  • Fax: 763-560-1850
Mailing address:
  • Phone: 763-300-4615
  • Fax: 763-560-1850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KOU TOU XIONG
Title or Position: PRESIDENT
Credential:
Phone: 763-300-4615