Provider Demographics
NPI:1053941799
Name:ROYAL CARE HOMECARE, LLC
Entity type:Organization
Organization Name:ROYAL CARE HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STACIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-309-3235
Mailing Address - Street 1:3624 29TH ST SE STE B
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49512-1885
Mailing Address - Country:US
Mailing Address - Phone:616-965-7004
Mailing Address - Fax:616-591-5683
Practice Address - Street 1:3624 29TH ST SE STE B
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49512-1885
Practice Address - Country:US
Practice Address - Phone:616-965-7004
Practice Address - Fax:616-591-5683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health