Provider Demographics
NPI:1659196525
Name:ROYALTY FAMILY HOME CARE
Entity type:Organization
Organization Name:ROYALTY FAMILY HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERS
Authorized Official - Prefix:
Authorized Official - First Name:JAMES, SIEDAH, BEV
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLMAN JR, WILLIS,BOSWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-779-7188
Mailing Address - Street 1:8128 W HERBERT AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218
Mailing Address - Country:US
Mailing Address - Phone:414-614-7026
Mailing Address - Fax:
Practice Address - Street 1:8128 W HERBERT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218
Practice Address - Country:US
Practice Address - Phone:414-614-7026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home