Provider Demographics
NPI:1114318854
Name:THE RESIDENCES AT ROYAL BELLINGHAM, INC.
Entity Type:Organization
Organization Name:THE RESIDENCES AT ROYAL BELLINGHAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LITO
Authorized Official - Middle Name:
Authorized Official - Last Name:VITUG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-980-2997
Mailing Address - Street 1:12229 CHANDLER BLVD
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-4395
Mailing Address - Country:US
Mailing Address - Phone:818-980-2997
Mailing Address - Fax:818-506-0364
Practice Address - Street 1:12229 CHANDLER BLVD
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-4395
Practice Address - Country:US
Practice Address - Phone:818-980-2997
Practice Address - Fax:818-506-0364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197608129310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility