Healthcare Provider Details

I. General information

NPI: 1720961980
Provider Name (Legal Business Name): ROYALTY PRODUCTIONS 419
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 YATES ST
TOLEDO OH
43608-2558
US

IV. Provider business mailing address

1320 YATES ST
TOLEDO OH
43608-2558
US

V. Phone/Fax

Practice location:
  • Phone: 419-819-2726
  • Fax:
Mailing address:
  • Phone: 419-819-2726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANTUANETTE RUSSELL
Title or Position: CEO
Credential:
Phone: 419-819-2726