MEDICARE: ROYAL LIFE CENTERS 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center		FL

General Provider Information

NPI Number	:	1518416999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL LIFE CENTERS LLC

Provider Business Mailing Address
First Line	:	701 S SWINTON AVE APT G
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33444-2377
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 SE 5TH AVE
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-5211
Country	:	US
Telephone Number	:	954-634-4425
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE
Name	:	FRANK CID
Credential	:
Telephone Number	:	954-634-4425

Provider Enumeration Date	:	09/27/2016
Last Update Date	:	09/27/2016

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Directions to “ROYAL LIFE CENTERS LLC ” Practice Location

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