Provider Demographics
NPI:1497835110
Name:ROYAL NURSING CENTER LLC
Entity Type:Organization
Organization Name:ROYAL NURSING CENTER LLC
Other - Org Name:ROYAL FALMOUTH NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-743-8159
Mailing Address - Street 1:545 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-3160
Mailing Address - Country:US
Mailing Address - Phone:508-548-3800
Mailing Address - Fax:508-548-6936
Practice Address - Street 1:545 MAIN ST
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-3160
Practice Address - Country:US
Practice Address - Phone:508-548-3800
Practice Address - Fax:508-548-6936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0697314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0925535Medicaid
MA0925535Medicaid