Provider Demographics
NPI:1356875280
Name:ROYAL DIRECT CARE SERVICE LLC
Entity type:Organization
Organization Name:ROYAL DIRECT CARE SERVICE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADRAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLISPIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-755-1027
Mailing Address - Street 1:11138 OLD SAINT CHARLES RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ANN
Mailing Address - State:MO
Mailing Address - Zip Code:63074-2113
Mailing Address - Country:US
Mailing Address - Phone:314-755-1027
Mailing Address - Fax:314-755-1028
Practice Address - Street 1:11138 OLD SAINT CHARLES RD
Practice Address - Street 2:
Practice Address - City:SAINT ANN
Practice Address - State:MO
Practice Address - Zip Code:63074-2113
Practice Address - Country:US
Practice Address - Phone:314-755-1027
Practice Address - Fax:314-755-1028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health