MEDICARE: ROYAL WA VANCOUVER, 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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1083400261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL WA VANCOUVER, LLC

Provider Business Mailing Address
First Line	:	1590 S CONGRESS AVE
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33406-5957
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8422 NE 8TH WAY
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98664-1974
Country	:	US
Telephone Number	:	509-768-3953
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CHRISTOPHER BRINEY
Credential	:
Telephone Number	:	805-512-1695

Provider Enumeration Date	:	04/16/2025
Last Update Date	:	04/16/2025

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