=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891935219
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROYAL DIRECT CARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2009
-----------------------------------------------------
Last Update Date | 04/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11140 OLD SAINT CHARLES RD
-----------------------------------------------------
City | SAINT ANN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63074-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-429-6949
-----------------------------------------------------
Fax | 314-429-6949
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11140 OLD SAINT CHARLES RD
-----------------------------------------------------
City | SAINT ANN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63074-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-429-6949
-----------------------------------------------------
Fax | 314-429-6949
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ADRAIN LYNN GILLISPIE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-429-6949
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------