Provider Demographics
NPI:1386748481
Name:ROYALTY PERSONAL ASSISTANCE SERVICE
Entity type:Organization
Organization Name:ROYALTY PERSONAL ASSISTANCE SERVICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:TOTTENHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:409-935-5962
Mailing Address - Street 1:4030 FM 1765
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591
Mailing Address - Country:US
Mailing Address - Phone:409-935-5962
Mailing Address - Fax:409-935-8093
Practice Address - Street 1:4030 FM 1765
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-4828
Practice Address - Country:US
Practice Address - Phone:409-935-5962
Practice Address - Fax:409-935-8093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX006577251E00000X
TX012613251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000105600Medicaid
TX001017224Medicaid