1174610794 NPI number — ROYALE HEALTH SYSTEMS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174610794 NPI number — ROYALE HEALTH SYSTEMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROYALE HEALTH SYSTEMS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174610794
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8645 S EASTERN AVE
Provider Second Line Business Mailing Address:
BLDG 110 STE.100B
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89123-2829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-791-0030
Provider Business Mailing Address Fax Number:
702-791-0031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8645 S EASTERN AVE
Provider Second Line Business Practice Location Address:
BLDG 110 STE. 100B
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89123-2829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-791-0030
Provider Business Practice Location Address Fax Number:
702-791-0031
Provider Enumeration Date:
10/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PIMENTEL
Authorized Official First Name:
JOY
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
702-791-0030

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 3312HHA-12 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)