=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215104096
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROYAL CARE A.C.L.F.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2008
-----------------------------------------------------
Last Update Date | 05/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5081 DUNN RD
-----------------------------------------------------
City | FORT PIERCE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34981-4942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-464-0728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5081 DUNN RD
-----------------------------------------------------
City | FORT PIERCE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34981-4942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-464-0728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ADMINISTATOR
-----------------------------------------------------
Name | MRS. PAULA N RAUCHETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 772-464-0728
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL7462
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------