Basic Information
| Provider Information | |||||||||
| NPI: | 1538249248 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ROYAL HEALTH GROUP LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ROYAL TABER STREET NURSING & REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19 TABER STREET | ||||||||
| Address2: | |||||||||
| City: | NEW BEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089970791 | ||||||||
| FaxNumber: | 5089915013 | ||||||||
| Practice Location | |||||||||
| Address1: | 19 TABER STREET | ||||||||
| Address2: | |||||||||
| City: | NEW BEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089970791 | ||||||||
| FaxNumber: | 5089915013 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 10/28/2013 | ||||||||
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| AuthorizedOfficialLastName: | REID | ||||||||
| AuthorizedOfficialFirstName: | PAULA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 5087438159 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 0658 | MA | N | Nursing & Custodial Care Facilities | Skilled Nursing Facility | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0926132 | 05 | MA | MEDICAID |