Provider Demographics
NPI:1710049192
Name:ROYAL HEALTHCARE OF AVON PARK,LLC.
Entity Type:Organization
Organization Name:ROYAL HEALTHCARE OF AVON PARK,LLC.
Other - Org Name:ROYAL CARE OF AVON PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:HALL
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-453-6674
Mailing Address - Street 1:1213 W STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-8091
Mailing Address - Country:US
Mailing Address - Phone:863-453-6674
Mailing Address - Fax:863-453-9473
Practice Address - Street 1:1213 W STRATFORD RD
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-8091
Practice Address - Country:US
Practice Address - Phone:863-453-6674
Practice Address - Fax:863-453-9473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF12290951314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL7BOtherBLUE CROSS BLUE SHIELD
FLL7BOtherBLUE CROSS BLUE SHIELD