MEDICARE: KINGS ROYAL CARE

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	305S00000X	Point of Service	NC60517152	WA

General Provider Information

NPI Number	:	1336599513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGS ROYAL CARE

Provider Business Mailing Address
First Line	:	16313 NE 80TH ST
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98682-1519
Country	:	US
Telephone Number	:	360-606-8990
Fax Number	:	360-331-4474

Provider Business Practice Location Address
First Line	:	8141 LOPEZ DR
Second Line	:
City	:	CLINTON
State	:	WA
Zip	:	98236-9236
Country	:	US
Telephone Number	:	360-730-1473
Fax Number	:	360-331-4474

Authorized Official
Title or Position	:	CAREGIVER
Name	:	KIMBERLY ANN KING
Credential	:	CNA
Telephone Number	:	360-606-8990

Provider Enumeration Date	:	06/17/2016
Last Update Date	:	06/17/2016

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Directions to “KINGS ROYAL CARE ” Practice Location

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