MEDICARE: ROYAL RESIDENTIAL HOME CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	374U00000X	Home Health Aide
3	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1366288144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL RESIDENTIAL HOME CARE

Provider Business Mailing Address
First Line	:	4352 WHITE COAT DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-8107
Country	:	US
Telephone Number	:	317-602-0139
Fax Number	:

Provider Business Practice Location Address
First Line	:	4352 WHITE COAT DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-8107
Country	:	US
Telephone Number	:	317-602-0139
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. DEAUNDRA P MCCUBBINS
Credential	:
Telephone Number	:	317-602-0139

Provider Enumeration Date	:	07/02/2024
Last Update Date	:	07/02/2024

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