Provider Demographics
NPI:1033685821
Name:ROYAL EAST SENIOR CARE, LLC
Entity Type:Organization
Organization Name:ROYAL EAST SENIOR CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-741-5929
Mailing Address - Street 1:329 W HWY 6 STE C
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-5574
Mailing Address - Country:US
Mailing Address - Phone:254-741-5929
Mailing Address - Fax:254-741-5928
Practice Address - Street 1:9101 PANTHERWAY
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8614
Practice Address - Country:US
Practice Address - Phone:254-741-5929
Practice Address - Fax:254-741-5928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility