Provider Demographics
NPI:1326405366
Name:RESIDENTIAL SERVICE AGENCY
Entity Type:Organization
Organization Name:RESIDENTIAL SERVICE AGENCY
Other - Org Name:ROYAL HEALTH SENIOR CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HABIBA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARUN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:612-245-3301
Mailing Address - Street 1:1004 TRAVIS LN
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3217
Mailing Address - Country:US
Mailing Address - Phone:612-245-3301
Mailing Address - Fax:
Practice Address - Street 1:1004 TRAVIS LN
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3217
Practice Address - Country:US
Practice Address - Phone:612-245-3301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health