Provider Demographics
NPI:1982068706
Name:ROYAL MISSIONS LLC.
Entity Type:Organization
Organization Name:ROYAL MISSIONS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MALLETT
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-427-2566
Mailing Address - Street 1:1662 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1547
Mailing Address - Country:US
Mailing Address - Phone:313-427-2566
Mailing Address - Fax:
Practice Address - Street 1:1662 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-1547
Practice Address - Country:US
Practice Address - Phone:313-427-2566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801087595171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty