Provider Demographics
NPI:1588660922
Name:ROYAL OAK NURSING CENTER, LLC
Entity Type:Organization
Organization Name:ROYAL OAK NURSING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-567-3122
Mailing Address - Street 1:37300 ROYAL OAK LN
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-5230
Mailing Address - Country:US
Mailing Address - Phone:352-567-3122
Mailing Address - Fax:352-567-2250
Practice Address - Street 1:37300 ROYAL OAK LN
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-5230
Practice Address - Country:US
Practice Address - Phone:352-567-3122
Practice Address - Fax:352-567-2250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF14840962314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022857500Medicaid
FL022857500Medicaid