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General NPI Number Information
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NPI Number | 1255322087
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Entity Type | Organization
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Legal Business Name | ROYAL PLAZA RETIREMENT CENTER LEWISTON, LLC
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Dates
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Enumeration Date | 11/01/2005
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 2870 JUNIPER DR
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City | LEWISTON
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State | ID
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Zip | 83501-4720
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Country | US
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Telephone | 208-746-2800
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Fax | 208-746-0164
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Provider Business Mailing Address
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Address Line | 2870 JUNIPER DR
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City | LEWISTON
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State | ID
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Zip | 83501-4720
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Country | US
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Telephone | 208-746-2800
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Fax | 208-746-0164
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Authorized Official
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Title or Position | MEMBER
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Name | MR. LARRY DEAN CHINN
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Credential |
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Telephone | 360-794-9020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 003266800
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License Number State | ID
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