Provider Demographics
NPI:1851056360
Name:ROYAL GROUP HOME, LLC
Entity Type:Organization
Organization Name:ROYAL GROUP HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SINTAYEHU
Authorized Official - Middle Name:
Authorized Official - Last Name:ABEBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-786-0891
Mailing Address - Street 1:6024 STODDARD CT APT 202
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5612
Mailing Address - Country:US
Mailing Address - Phone:703-786-0891
Mailing Address - Fax:703-594-8532
Practice Address - Street 1:6024 STODDARD CT APT 202
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5612
Practice Address - Country:US
Practice Address - Phone:703-786-0891
Practice Address - Fax:703-594-8532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities