Healthcare Provider Details

I. General information

NPI: 1487717377
Provider Name (Legal Business Name): ROYALTEE IN-HOME SERVICE, LLCV
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W CHURCH ST
QUITMAN MS
39355-2134
US

IV. Provider business mailing address

111 W CHURCH ST
QUITMAN MS
39355-2134
US

V. Phone/Fax

Practice location:
  • Phone: 601-776-3230
  • Fax: 601-776-3231
Mailing address:
  • Phone: 601-776-3230
  • Fax: 601-776-3231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ROSIE M BERRY
Title or Position: OWNER SINGLE MEMBER
Credential:
Phone: 601-776-3230