Provider Demographics
NPI:1851646871
Name:ROYAL HEALTHCARE OF SOUTHWEST FLORIDA LLC
Entity Type:Organization
Organization Name:ROYAL HEALTHCARE OF SOUTHWEST FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-674-0086
Mailing Address - Street 1:4580 ANDOVER WAY
Mailing Address - Street 2:B 202
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-7250
Mailing Address - Country:US
Mailing Address - Phone:732-674-0086
Mailing Address - Fax:239-793-6645
Practice Address - Street 1:4580 ANDOVER WAY
Practice Address - Street 2:B 202
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-7250
Practice Address - Country:US
Practice Address - Phone:732-674-0086
Practice Address - Fax:239-793-6645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9253566305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service