Provider Demographics
NPI:1851830947
Name:ROYAL CARE HOME LLC
Entity Type:Organization
Organization Name:ROYAL CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:K
Authorized Official - Last Name:BALIAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-514-8837
Mailing Address - Street 1:2122 HARTSTONE DR SE
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-7880
Mailing Address - Country:US
Mailing Address - Phone:616-514-8837
Mailing Address - Fax:
Practice Address - Street 1:507 FULLER AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-2526
Practice Address - Country:US
Practice Address - Phone:616-514-8837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS410347272320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities