MEDICARE: ROYALTON SENIOR LIVING, INC.

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	310400000X	Assisted Living Facility	2009R	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295912293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYALTON SENIOR LIVING, INC.

Provider Business Mailing Address
First Line	:	14277 STATE RD
Second Line	:
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-5130
Country	:	US
Telephone Number	:	440-582-4111
Fax Number	:	440-230-2974

Provider Business Practice Location Address
First Line	:	14277 STATE RD
Second Line	:
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-5130
Country	:	US
Telephone Number	:	440-582-4111
Fax Number	:	440-230-2974

Authorized Official
Title or Position	:	BOARD DIRECTOR
Name	:	JOHN M COURY
Credential	:
Telephone Number	:	440-243-5668

Provider Enumeration Date	:	01/22/2008
Last Update Date	:	01/28/2008

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