Provider Demographics
NPI:1093259657
Name:ROYALTY ENTERPRISES LLC
Entity Type:Organization
Organization Name:ROYALTY ENTERPRISES LLC
Other - Org Name:ROYALTY CONSUMER DIRECTED SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAWANA
Authorized Official - Middle Name:LATRICE
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-397-6578
Mailing Address - Street 1:3748 DELOR ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-4154
Mailing Address - Country:US
Mailing Address - Phone:314-706-2854
Mailing Address - Fax:
Practice Address - Street 1:3748 DELOR ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116-4154
Practice Address - Country:US
Practice Address - Phone:314-706-2854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care