Provider Demographics
NPI:1609316389
Name:ROYALTY INTERVENTION GROUP, INC
Entity Type:Organization
Organization Name:ROYALTY INTERVENTION GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RATCLIFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-779-8260
Mailing Address - Street 1:2215 W 95TH ST
Mailing Address - Street 2:1 EAST
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1001
Mailing Address - Country:US
Mailing Address - Phone:773-239-9600
Mailing Address - Fax:773-239-9601
Practice Address - Street 1:2215 W 95TH ST
Practice Address - Street 2:1 EAST
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1001
Practice Address - Country:US
Practice Address - Phone:773-779-8260
Practice Address - Fax:773-779-8261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1609316389Medicaid