=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821283573
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROYAL LIVING CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2007
-----------------------------------------------------
Last Update Date | 09/06/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 SOUTH 9TH STREET
-----------------------------------------------------
City | NEW BADEN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-588-7295
-----------------------------------------------------
Fax | 618-588-7290
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 SOUTH 9TH STREET
-----------------------------------------------------
City | NEW BADEN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-588-7295
-----------------------------------------------------
Fax | 618-588-7290
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. DOLORES JEAN KREBS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 618-588-7295
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------