Provider Demographics
NPI:1336599513
Name:KINGS ROYAL CARE
Entity Type:Organization
Organization Name:KINGS ROYAL CARE
Other - Org Name:KINGS ROYAL CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CAREGIVER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:360-606-8990
Mailing Address - Street 1:16313 NE 80TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-1519
Mailing Address - Country:US
Mailing Address - Phone:360-606-8990
Mailing Address - Fax:360-331-4474
Practice Address - Street 1:8141 LOPEZ DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:WA
Practice Address - Zip Code:98236-9236
Practice Address - Country:US
Practice Address - Phone:360-730-1473
Practice Address - Fax:360-331-4474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC60517152305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service