Provider Demographics
NPI:1306827415
Name:ROYAL CONVALESCENT HOSPITAL INC.
Entity Type:Organization
Organization Name:ROYAL CONVALESCENT HOSPITAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-344-5431
Mailing Address - Street 1:320 CATTLE CALL DR
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-3108
Mailing Address - Country:US
Mailing Address - Phone:760-344-5431
Mailing Address - Fax:760-344-8240
Practice Address - Street 1:320 CATTLE CALL DR
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-3108
Practice Address - Country:US
Practice Address - Phone:760-344-5431
Practice Address - Fax:760-344-8240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZZT05893G314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05893GMedicaid
CAZZT05893GMedicaid