Provider Demographics
NPI:1962465898
Name:ROYAL HOME HEALTH, LLC
Entity Type:Organization
Organization Name:ROYAL HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LATRENA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:KIRKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:248-582-9221
Mailing Address - Street 1:26711 WOODWARD AVE
Mailing Address - Street 2:STE. 205
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1333
Mailing Address - Country:US
Mailing Address - Phone:248-582-9221
Mailing Address - Fax:248-582-9226
Practice Address - Street 1:26711 WOODWARD AVE
Practice Address - Street 2:STE. 205
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1333
Practice Address - Country:US
Practice Address - Phone:248-582-9221
Practice Address - Fax:248-582-9226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI237570251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI237570Medicare ID - Type UnspecifiedMEDICARE NUMBER