Provider Demographics
NPI:1821283573
Name:ROYAL LIVING CENTER INC
Entity Type:Organization
Organization Name:ROYAL LIVING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:KREBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-588-7295
Mailing Address - Street 1:200 SOUTH 9TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW BADEN
Mailing Address - State:IL
Mailing Address - Zip Code:62265
Mailing Address - Country:US
Mailing Address - Phone:618-588-7295
Mailing Address - Fax:618-588-7290
Practice Address - Street 1:200 SOUTH 9TH STREET
Practice Address - Street 2:
Practice Address - City:NEW BADEN
Practice Address - State:IL
Practice Address - Zip Code:62265
Practice Address - Country:US
Practice Address - Phone:618-588-7295
Practice Address - Fax:618-588-7290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0039743Medicaid