MEDICARE: ROYAL TREATMENT PERSONAL CARE, 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1952600306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL TREATMENT PERSONAL CARE, LLC

Provider Business Mailing Address
First Line	:	1214 PINE BURR RD
Second Line	:
City	:	COLUMBIA
State	:	MS
Zip	:	39429-9362
Country	:	US
Telephone Number	:	601-731-9883
Fax Number	:

Provider Business Practice Location Address
First Line	:	1214 PINE BURR RD
Second Line	:
City	:	COLUMBIA
State	:	MS
Zip	:	39429-9362
Country	:	US
Telephone Number	:	601-731-9883
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	RICKY MCKENZIE
Credential	:
Telephone Number	:	601-731-9883

Provider Enumeration Date	:	03/24/2011
Last Update Date	:	03/24/2011

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