Healthcare Provider Details

I. General information

NPI: 1134284250
Provider Name (Legal Business Name): ROYAL CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 MEADOWLARK LN
EXCELSIOR SPRINGS MO
64024-3304
US

IV. Provider business mailing address

1003 MEADOWLARK LN
EXCELSIOR SPRINGS MO
64024-3304
US

V. Phone/Fax

Practice location:
  • Phone: 816-630-3145
  • Fax: 816-630-3147
Mailing address:
  • Phone: 816-630-3145
  • Fax: 816-630-3147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number033460
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. JESSE HWANG
Title or Position: ADMINISTRATOR
Credential:
Phone: 816-630-3145