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General NPI Number Information
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NPI Number | 1265609853
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Entity Type | Organization
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Legal Business Name | ROYAL DESTINY HOME CARE LLC
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Dates
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Enumeration Date | 05/13/2008
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | 3260 NW 179TH ST
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City | MIAMI GARDENS
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State | FL
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Zip | 33056-3416
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Country | US
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Telephone | 305-474-3273
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Fax | 305-474-3278
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Provider Business Mailing Address
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Address Line | 3260 NW 179TH ST
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City | MIAMI GARDENS
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State | FL
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Zip | 33056-3416
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Country | US
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Telephone | 305-474-3273
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Fax | 305-474-3278
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Authorized Official
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Title or Position | OWNER/ ADMINISTRATOR
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Name | MRS. EVELYN J BRANFORD
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Credential |
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Telephone | 305-474-3273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL10731
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License Number State | FL
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