Healthcare Provider Details

I. General information

NPI: 1073552477
Provider Name (Legal Business Name): ROYAL LANE HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9114 ROYAL LN
WACO TX
76712-8469
US

IV. Provider business mailing address

9114 ROYAL LN
WACO TX
76712-8469
US

V. Phone/Fax

Practice location:
  • Phone: 254-666-2164
  • Fax: 254-666-9330
Mailing address:
  • Phone: 254-666-2164
  • Fax: 254-666-9330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number105589
License Number StateTX

VIII. Authorized Official

Name: MS. TAMMY F JOHNSON
Title or Position: ADMINISTRATOR
Credential: B.S., LNFA
Phone: 254-666-2164