Provider Demographics
NPI:1558082255
Name:ROYAL VISTA ASSISTING LIVING, INC.
Entity Type:Organization
Organization Name:ROYAL VISTA ASSISTING LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSEMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:JEANTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-710-2807
Mailing Address - Street 1:4922 JORDAN AVE
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33973-6047
Mailing Address - Country:US
Mailing Address - Phone:239-710-2807
Mailing Address - Fax:239-799-7388
Practice Address - Street 1:4922 JORDAN AVE
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33973-6047
Practice Address - Country:US
Practice Address - Phone:239-710-2807
Practice Address - Fax:239-799-7388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility