Healthcare Provider Details

I. General information

NPI: 1033685821
Provider Name (Legal Business Name): ROYAL EAST SENIOR CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 PANTHERWAY
WACO TX
76712-8614
US

IV. Provider business mailing address

329 W HWY 6 STE C
WACO TX
76710-5574
US

V. Phone/Fax

Practice location:
  • Phone: 254-741-5929
  • Fax: 254-741-5928
Mailing address:
  • Phone: 254-741-5929
  • Fax: 254-741-5928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JACK COOK
Title or Position: MEMBER
Credential:
Phone: 254-741-5929