MEDICARE: ROYAL HEALTH SERVICE 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1386938025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL HEALTH SERVICE INC

Provider Business Mailing Address
First Line	:	2718 NICOLLET AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-1648
Country	:	US
Telephone Number	:	612-987-1120
Fax Number	:

Provider Business Practice Location Address
First Line	:	2718 NICOLLET AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-1648
Country	:	US
Telephone Number	:	612-987-1120
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MOHAMED KODAH
Credential	:
Telephone Number	:	612-987-1120

Provider Enumeration Date	:	05/28/2011
Last Update Date	:	05/28/2011

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Directions to “ROYAL HEALTH SERVICE INC ” Practice Location

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