Provider Demographics
NPI:1144997925
Name:ROYAL GARDEN
Entity type:Organization
Organization Name:ROYAL GARDEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:MANGOSING
Authorized Official - Last Name:TABLADILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-829-1860
Mailing Address - Street 1:39 G ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3138
Mailing Address - Country:US
Mailing Address - Phone:161-982-9186
Mailing Address - Fax:
Practice Address - Street 1:39 G ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3138
Practice Address - Country:US
Practice Address - Phone:161-982-9186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility