Healthcare Provider Details

I. General information

NPI: 1932941259
Provider Name (Legal Business Name): ROYAL DESTINY HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 FIELDCREST AVENUE 3RD FLOOR 3RD FLOOR PMB 9271
EDISON NJ
08837
US

IV. Provider business mailing address

110 FIELDCREST AVENUE 3RD FLOOR 3RD FLOOR PMB 9271
EDISON NJ
08837
US

V. Phone/Fax

Practice location:
  • Phone: 877-225-6630
  • Fax: 838-910-3039
Mailing address:
  • Phone: 877-225-6630
  • Fax: 838-910-3039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ISAAC ADEOYE AJAYI
Title or Position: PRESIDENT
Credential:
Phone: 877-225-6630