Provider Demographics
NPI:1538505367
Name:ROYAL HOME SUPPORT
Entity Type:Organization
Organization Name:ROYAL HOME SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARA PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-462-6651
Mailing Address - Street 1:5309 TARTAN CIR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-4608
Mailing Address - Country:US
Mailing Address - Phone:866-803-4222
Mailing Address - Fax:
Practice Address - Street 1:5309 TARTAN CIR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-4608
Practice Address - Country:US
Practice Address - Phone:361-462-6651
Practice Address - Fax:866-803-4222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service