MEDICARE: ROYAL MISSIONS 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	171W00000X	Contractor	6801087595	MI

General Provider Information

NPI Number	:	1982068706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL MISSIONS LLC.

Provider Business Mailing Address
First Line	:	1662 ORCHARD DR
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-1547
Country	:	US
Telephone Number	:	313-427-2566
Fax Number	:

Provider Business Practice Location Address
First Line	:	1662 ORCHARD DR
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-1547
Country	:	US
Telephone Number	:	313-427-2566
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. GRACE M MALLETT
Credential	:	LMSW
Telephone Number	:	313-427-2566

Provider Enumeration Date	:	04/07/2016
Last Update Date	:	04/07/2016

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Directions to “ROYAL MISSIONS LLC. ” Practice Location

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