Provider Demographics
NPI:1386054369
Name:ROYALTY CARE HOME HEALTH SERVICES LLC
Entity type:Organization
Organization Name:ROYALTY CARE HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSALBA
Authorized Official - Middle Name:
Authorized Official - Last Name:PINERO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:239-243-0512
Mailing Address - Street 1:12734 KENWOOD LN
Mailing Address - Street 2:5 AND 6
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5638
Mailing Address - Country:US
Mailing Address - Phone:239-243-0512
Mailing Address - Fax:239-437-9730
Practice Address - Street 1:12734 KENWOOD LANE
Practice Address - Street 2:5 AND 6
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907
Practice Address - Country:US
Practice Address - Phone:239-243-0512
Practice Address - Fax:239-437-9730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015357600Medicaid