Provider Demographics
NPI:1548787252
Name:ROYALTY BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:ROYALTY BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-756-3632
Mailing Address - Street 1:8600 W CHARLESTON BLVD APT 1025
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5408
Mailing Address - Country:US
Mailing Address - Phone:702-756-3632
Mailing Address - Fax:
Practice Address - Street 1:8600 W CHARLESTON BLVD APT 1025
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5408
Practice Address - Country:US
Practice Address - Phone:702-756-3632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROYALTY BEHAVIORAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health