Provider Demographics
NPI:1407336118
Name:ROYAL STAR RESIDENCE, INC.
Entity Type:Organization
Organization Name:ROYAL STAR RESIDENCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:KANMUE
Authorized Official - Last Name:KOLLEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-442-5136
Mailing Address - Street 1:5701 SHINGLE CREEK PKWY N
Mailing Address - Street 2:SUITE 500Q
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2386
Mailing Address - Country:US
Mailing Address - Phone:763-442-5136
Mailing Address - Fax:
Practice Address - Street 1:5701 SHINGLE CREEK PKWY N
Practice Address - Street 2:SUITE 500Q
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2386
Practice Address - Country:US
Practice Address - Phone:763-442-5136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-21
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care