Royal Crystals LLC

Primary specialty

Public Health or Welfare AgencyTaxonomy code 251K00000X

Legal business name

ROYAL CRYSTALS LLC

Practice address

832 142ND Ave NE
Ham Lake, MN 55304-6757

Phone

(612) 203-4758

NPI assigned

Mar 14, 2023

Last updated

Mar 14, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Matilda Pokuaah Agyapong, RN,BSN, ALD

Title

Owner

Phone

(612) 203-4758

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1678752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678752000000",
    "number": "1093416372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "832 142ND AVE NE",
            "city": "HAM LAKE",
            "state": "MN",
            "postal_code": "553046757",
            "telephone_number": "612-203-4758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "832 142ND AVE NE",
            "city": "HAM LAKE",
            "state": "MN",
            "postal_code": "553046757",
            "telephone_number": "612-203-4758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROYAL CRYSTALS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-14",
        "last_updated": "2023-03-14",
        "certification_date": "2023-03-14",
        "status": "A",
        "authorized_official_last_name": "AGYAPONG",
        "authorized_official_first_name": "MATILDA",
        "authorized_official_middle_name": "POKUAAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-203-4758",
        "authorized_official_credential": "RN,BSN, ALD"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Oakland Assisted Living LLC
• Oakland Assisted Living LLC
• Jeffrey Peterson, ATC
• Physical Therapy Consultants, Inc. (Ham Lake Physical Therapy)
• Michele Marie Revoir, DDS
• Leyla Sanati-Zaker, DC
• Karl Ritchie Schlotterbeck, LP
• Kathrine Schmit
• Danielle Smith, RN
• Hayley Lynn Stumne, DC

• Public Health or Welfare Agency in Ham Lake, MN
• Providers in Ham Lake, MN by specialty
• Public Health or Welfare Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2023; 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.