Provider Demographics
NPI:1497226179
Name:ROYALTY CONSUMER DIRECTED SERVICE LLC
Entity Type:Organization
Organization Name:ROYALTY CONSUMER DIRECTED SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATARA
Authorized Official - Middle Name:RANIECE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-757-8357
Mailing Address - Street 1:PO BOX 11027
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63135-0027
Mailing Address - Country:US
Mailing Address - Phone:314-757-8357
Mailing Address - Fax:314-528-6786
Practice Address - Street 1:4625 LINDELL BLVD STE 214
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-3729
Practice Address - Country:US
Practice Address - Phone:314-757-8357
Practice Address - Fax:314-528-6786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health