Provider Demographics
NPI:1215383138
Name:ROYAL LIFE CENTERS, LLC
Entity Type:Organization
Organization Name:ROYAL LIFE CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:CID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-270-3481
Mailing Address - Street 1:701 S SWINTON AVE
Mailing Address - Street 2:APT G
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-2377
Mailing Address - Country:US
Mailing Address - Phone:561-270-3481
Mailing Address - Fax:
Practice Address - Street 1:8645 MARTIN WAY E
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-5851
Practice Address - Country:US
Practice Address - Phone:561-270-3481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder