=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891559464
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROYAL FAMILY DIRECT CARE SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2024
-----------------------------------------------------
Last Update Date | 03/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11138 OLD SAINT CHARLES RD
-----------------------------------------------------
City | SAINT ANN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63074-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-755-1095
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11138 OLD SAINT CHARLES RD
-----------------------------------------------------
City | SAINT ANN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63074-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-755-1095
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | CHARLNISHIA WILKINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-445-8304
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------