Provider Demographics
NPI:1639568686
Name:ROYAL HOME CARE OF NORTH CAROLINA, LLC
Entity Type:Organization
Organization Name:ROYAL HOME CARE OF NORTH CAROLINA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHETVISAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-957-5774
Mailing Address - Street 1:PO BOX 36409
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27416-6409
Mailing Address - Country:US
Mailing Address - Phone:800-681-8497
Mailing Address - Fax:844-852-7565
Practice Address - Street 1:2530 MERIDIAN PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-5272
Practice Address - Country:US
Practice Address - Phone:800-681-8497
Practice Address - Fax:844-852-7565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3990253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHC3990Medicaid