NPIMap

Organization Active NPI

Royal Az LLC

  • Substance Abuse Rehabilitation Facility
  • Prescott, AZ
National Provider Identifier
1013668219
Registry record updated Mar 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
ROYAL AZ LLC
Doing business as
Royal Life Centers
Practice address
831 Gail Gardner Way
Prescott, AZ 86305-1606
Phone
(855) 468-3389
NPI assigned
Jan 10, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shandalee Jackson
Title
Credentialing Manager
Phone
(561) 562-6271

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

831 Gail Gardner Way
Prescott, AZ 86305-1606

Mailing address

1590 S Congress Ave
Palm Springs, FL 33406-5957
Phone (561) 562-6271

Other names 1

  • Royal Life Centers Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Royal Az LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

831 Gail Gardner Way
Prescott, AZ 86305
Phone (928) 445-3834

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1641772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647907200000",
    "number": "1013668219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1590 S CONGRESS AVE",
            "city": "PALM SPRINGS",
            "state": "FL",
            "postal_code": "334065957",
            "telephone_number": "561-562-6271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "831 GAIL GARDNER WAY",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863051606",
            "telephone_number": "855-468-3389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROYAL AZ LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-10",
        "last_updated": "2022-03-22",
        "certification_date": "2022-03-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "SHANDALEE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "561-562-6271"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Royal Life Centers",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Royal Life Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prescott, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.