Provider Demographics
NPI:1285813121
Name:ROYAL GARDENS OF ST. CLOUD,LLC
Entity type:Organization
Organization Name:ROYAL GARDENS OF ST. CLOUD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:GALDO
Authorized Official - Last Name:PABELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:407-892-2290
Mailing Address - Street 1:4511 NEPTUNE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-6738
Mailing Address - Country:US
Mailing Address - Phone:407-892-2290
Mailing Address - Fax:407-892-1141
Practice Address - Street 1:4511 NEPTUNE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6738
Practice Address - Country:US
Practice Address - Phone:407-892-2290
Practice Address - Fax:407-892-1141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-28
Last Update Date:2007-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL5555310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility