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General NPI Number Information
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NPI Number | 1851646871
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Entity Type | Organization
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Legal Business Name | ROYAL HEALTHCARE OF SOUTHWEST FLORIDA LLC
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Dates
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Enumeration Date | 07/16/2012
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Last Update Date | 07/16/2012
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Provider Practice Location Address
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Address Line | 4580 ANDOVER WAY B 202
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City | NAPLES
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State | FL
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Zip | 34112-7250
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Country | US
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Telephone | 732-674-0086
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Fax | 239-793-6645
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Provider Business Mailing Address
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Address Line | 4580 ANDOVER WAY B 202
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City | NAPLES
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State | FL
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Zip | 34112-7250
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Country | US
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Telephone | 732-674-0086
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Fax | 239-793-6645
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | VALERIE HAHN
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Credential |
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Telephone | 732-674-0086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 9253566
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License Number State | FL
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