MEDICARE: ROYAL FAMILY COMMUNITY SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1003550591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL FAMILY COMMUNITY SERVICES LLC

Provider Business Mailing Address
First Line	:	280 CHARLES H DIMMOCK PKWY STE 1
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2940
Country	:	US
Telephone Number	:	804-709-2053
Fax Number	:	804-805-8694

Provider Business Practice Location Address
First Line	:	280 CHARLES H DIMMOCK PKWY STE 1
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2940
Country	:	US
Telephone Number	:	804-805-8694
Fax Number	:	804-805-8694

Authorized Official
Title or Position	:	CEO
Name	:	LILITIA IBEKWE
Credential	:	LMHP-S
Telephone Number	:	804-709-2053

Provider Enumeration Date	:	04/21/2022
Last Update Date	:	03/17/2025

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