Provider Demographics
NPI:1487717377
Name:ROYALTEE IN-HOME SERVICE, LLCV
Entity type:Organization
Organization Name:ROYALTEE IN-HOME SERVICE, LLCV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SINGLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROSIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-776-3230
Mailing Address - Street 1:111 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:MS
Mailing Address - Zip Code:39355-2134
Mailing Address - Country:US
Mailing Address - Phone:601-776-3230
Mailing Address - Fax:601-776-3231
Practice Address - Street 1:111 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:MS
Practice Address - Zip Code:39355-2134
Practice Address - Country:US
Practice Address - Phone:601-776-3230
Practice Address - Fax:601-776-3231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770490Medicaid
MS04821746Medicaid
MS06289599Medicaid