Provider Demographics
NPI:1538348883
Name:ROYALTY RENOVATIONS INC DBA
Entity type:Organization
Organization Name:ROYALTY RENOVATIONS INC DBA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAID WAIVER PROVIDER-ADMINISTRA
Authorized Official - Prefix:
Authorized Official - First Name:DANE
Authorized Official - Middle Name:MCCAL
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-909-3710
Mailing Address - Street 1:1521 AVONDALE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33567-3684
Mailing Address - Country:US
Mailing Address - Phone:823-909-3710
Mailing Address - Fax:
Practice Address - Street 1:6803 S HIMES AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-5129
Practice Address - Country:US
Practice Address - Phone:813-909-3710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROYALTY RENOVATIONS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities