Basic Information
| Provider Information | |||||||||
| NPI: | 1588660922 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROYAL OAK NURSING CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 37300 ROYAL OAK LN | ||||||||
| Address2: | |||||||||
| City: | DADE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335255230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525673122 | ||||||||
| FaxNumber: | 3525672250 | ||||||||
| Practice Location | |||||||||
| Address1: | 37300 ROYAL OAK LN | ||||||||
| Address2: | |||||||||
| City: | DADE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335255230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525673122 | ||||||||
| FaxNumber: | 3525672250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2005 | ||||||||
| LastUpdateDate: | 04/04/2012 | ||||||||
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| AuthorizedOfficialLastName: | HOWARD | ||||||||
| AuthorizedOfficialFirstName: | ANITA | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3525673122 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | SNF14840962 | FL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 022857500 | 05 | FL | MEDICAID |