Provider Demographics
NPI:1669041653
Name:ROYAL ASSISTED LIVING INC
Entity Type:Organization
Organization Name:ROYAL ASSISTED LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHIONA
Authorized Official - Middle Name:QUINCY
Authorized Official - Last Name:BAREEBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-703-6078
Mailing Address - Street 1:453 OAKTON RD
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1604
Mailing Address - Country:US
Mailing Address - Phone:443-214-3028
Mailing Address - Fax:
Practice Address - Street 1:453 OAKTON RD
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1604
Practice Address - Country:US
Practice Address - Phone:443-214-3028
Practice Address - Fax:443-458-6278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility