Provider Demographics
NPI:1366642233
Name:ROYAL TREATMENT HEALTH SYSTEMS, LLC.
Entity Type:Organization
Organization Name:ROYAL TREATMENT HEALTH SYSTEMS, LLC.
Other - Org Name:OASIS HEALTH SYSTEMS
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARYKE
Authorized Official - Middle Name:
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-609-6976
Mailing Address - Street 1:2450 LAWRENCEVILLE HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3268
Mailing Address - Country:US
Mailing Address - Phone:770-609-6976
Mailing Address - Fax:404-601-9622
Practice Address - Street 1:2450 LAWRENCEVILLE HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3268
Practice Address - Country:US
Practice Address - Phone:770-609-6976
Practice Address - Fax:404-601-9622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA623782347AMedicaid