Provider Demographics
NPI:1821395096
Name:ROYAL RESIDENTIAL SERVICES
Entity Type:Organization
Organization Name:ROYAL RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:OGBUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-338-7793
Mailing Address - Street 1:6379 SHADOWSHAPE PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4527
Mailing Address - Country:US
Mailing Address - Phone:301-379-1564
Mailing Address - Fax:
Practice Address - Street 1:6379 SHADOWSHAPE PL
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-4527
Practice Address - Country:US
Practice Address - Phone:301-379-1564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD740700900251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD740700900Medicaid