MEDICARE: ROYAL HOMEMAKER AND COMPANION

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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1316596299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL HOMEMAKER AND COMPANION

Provider Business Mailing Address
First Line	:	4005 ARBOR MILL CIR
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32065-3216
Country	:	US
Telephone Number	:	904-644-7639
Fax Number	:

Provider Business Practice Location Address
First Line	:	4005 ARBOR MILL CIR
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32065-3216
Country	:	US
Telephone Number	:	904-644-7639
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MONICA E SEGALL
Credential	:
Telephone Number	:	904-644-7639

Provider Enumeration Date	:	09/04/2019
Last Update Date	:	09/04/2019

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