Provider Demographics
NPI:1629346259
Name:VICTOR ROYALE
Entity Type:Organization
Organization Name:VICTOR ROYALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:V
Authorized Official - Last Name:BABAIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:818-243-7442
Mailing Address - Street 1:120 E LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3113
Mailing Address - Country:US
Mailing Address - Phone:818-243-7442
Mailing Address - Fax:818-688-8178
Practice Address - Street 1:120 E LAUREL ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-3113
Practice Address - Country:US
Practice Address - Phone:818-243-7442
Practice Address - Fax:818-688-8178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197605718310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility