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General NPI Number Information
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NPI Number | 1780055624
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Entity Type | Organization
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Legal Business Name | ROYAL ESTATES ASSISTIVE LIVING LLC
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Dates
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Enumeration Date | 10/19/2015
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Last Update Date | 10/19/2015
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Provider Practice Location Address
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Address Line | 1515 E 154TH ST.
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City | DOLTON
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State | IL
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Zip | 60419
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Country | US
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Telephone | 708-841-5560
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Fax | 708-849-4676
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Provider Business Mailing Address
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Address Line | PO BOX 597665
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City | CHICAGO
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State | IL
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Zip | 60659
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Country | US
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Telephone | 847-452-6804
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Fax | 773-305-2998
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Authorized Official
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Title or Position | CO MANAGER
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Name | MR. MARC SIEBZENER
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Credential |
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Telephone | 847-452-6804
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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 |
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License Number State |
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