MEDICARE: ROYAL LEGACY EMPIRE 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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1366283988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL LEGACY EMPIRE LLC

Provider Business Mailing Address
First Line	:	12500 OLD HAMMOND HWY APT G2
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-1091
Country	:	US
Telephone Number	:	225-366-9548
Fax Number	:

Provider Business Practice Location Address
First Line	:	4581 PEERLESS ST
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70811-5430
Country	:	US
Telephone Number	:	225-206-4064
Fax Number	:

Authorized Official
Title or Position	:	LICENSED ADDICTION COUNSELOR
Name	:	JENA' CARMALETA DENNIS
Credential	:	LMSW, LAC, AADC
Telephone Number	:	225-366-9548

Provider Enumeration Date	:	06/06/2024
Last Update Date	:	06/30/2026

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Directions to “ROYAL LEGACY EMPIRE LLC ” Practice Location

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