Provider Demographics
NPI:1063964641
Name:ROYAL LIVING HOME, INC.
Entity type:Organization
Organization Name:ROYAL LIVING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SEPIDEH
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDAGHATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-666-6681
Mailing Address - Street 1:321 ROYAL AVE
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-4129
Mailing Address - Country:US
Mailing Address - Phone:805-624-7036
Mailing Address - Fax:
Practice Address - Street 1:321 ROYAL AVE
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-4129
Practice Address - Country:US
Practice Address - Phone:805-624-7036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility