Provider Demographics
NPI:1083364335
Name:ROYAL GROUP HOME LLC
Entity Type:Organization
Organization Name:ROYAL GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MBUGUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-955-9155
Mailing Address - Street 1:5510 W ELLIS DR
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2970
Mailing Address - Country:US
Mailing Address - Phone:480-955-9155
Mailing Address - Fax:
Practice Address - Street 1:563 N 43RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009
Practice Address - Country:US
Practice Address - Phone:480-955-9155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness