Provider Demographics
NPI:1932472180
Name:ROYAL COTTAGE INC
Entity Type:Organization
Organization Name:ROYAL COTTAGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-256-3194
Mailing Address - Street 1:65 STONEY POINT TER
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-7070
Mailing Address - Country:US
Mailing Address - Phone:678-261-8125
Mailing Address - Fax:
Practice Address - Street 1:65 STONEY POINT TER
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-7070
Practice Address - Country:US
Practice Address - Phone:678-261-8125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA107-01-071-1320700000X, 323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility