Provider Demographics
NPI:1417343435
Name:ROYAL CONGREGATE LIVING FACILITY
Entity Type:Organization
Organization Name:ROYAL CONGREGATE LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/VEO
Authorized Official - Prefix:
Authorized Official - First Name:KENECHUKWU
Authorized Official - Middle Name:
Authorized Official - Last Name:UDOH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-313-9388
Mailing Address - Street 1:3100 MILDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-4740
Mailing Address - Country:US
Mailing Address - Phone:661-579-6898
Mailing Address - Fax:661-244-0115
Practice Address - Street 1:3100 MILDWOOD CT
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-4740
Practice Address - Country:US
Practice Address - Phone:661-579-6898
Practice Address - Fax:661-244-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility