Provider Demographics
NPI:1588797484
Name:ROYAL HEALTHCARE OF NORTH CAROLINA,INC
Entity Type:Organization
Organization Name:ROYAL HEALTHCARE OF NORTH CAROLINA,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:B
Authorized Official - Last Name:FOWOWE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:919-326-9470
Mailing Address - Street 1:4124 VIEWMONT DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-5334
Mailing Address - Country:US
Mailing Address - Phone:919-326-5265
Mailing Address - Fax:919-755-0347
Practice Address - Street 1:4124 VIEWMONT DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-5334
Practice Address - Country:US
Practice Address - Phone:919-326-5265
Practice Address - Fax:919-755-0347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3083251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601317Medicaid