Provider Demographics
NPI:1124390588
Name:ROYAL LIVING, INC.
Entity type:Organization
Organization Name:ROYAL LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RANESHA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:JOHNOSN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-627-2165
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-0647
Mailing Address - Country:US
Mailing Address - Phone:770-627-2165
Mailing Address - Fax:
Practice Address - Street 1:313 THORNCLIFF LNDG
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-2665
Practice Address - Country:US
Practice Address - Phone:770-627-2165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA110R0920314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility