Provider Demographics
NPI:1659040798
Name:ROYAL HEART ASSISTED LIVING FACILITY
Entity Type:Organization
Organization Name:ROYAL HEART ASSISTED LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALM
Authorized Official - Prefix:MRS
Authorized Official - First Name:NGOZI
Authorized Official - Middle Name:GLORIA
Authorized Official - Last Name:WILKENS
Authorized Official - Suffix:
Authorized Official - Credentials:NGOZI GLORIA WILKENS
Authorized Official - Phone:443-642-9933
Mailing Address - Street 1:3604 WHITE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-3412
Mailing Address - Country:US
Mailing Address - Phone:410-469-9022
Mailing Address - Fax:410-444-1847
Practice Address - Street 1:3604 WHITE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-3412
Practice Address - Country:US
Practice Address - Phone:410-469-9022
Practice Address - Fax:410-444-1847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-11
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility