Provider Demographics
NPI:1700328747
Name:ROYAL CARE I INC
Entity type:Organization
Organization Name:ROYAL CARE I INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LASHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-520-1328
Mailing Address - Street 1:1505 S US HIGHWAY 301
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-5002
Mailing Address - Country:US
Mailing Address - Phone:813-520-1328
Mailing Address - Fax:813-532-3643
Practice Address - Street 1:3530 1ST AVE N STE 218
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8444
Practice Address - Country:US
Practice Address - Phone:813-520-1328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROYAL CARE I INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-08
Last Update Date:2024-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
261QD1600X, 385H00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118878800Medicaid
FL102758700Medicaid