NPIMap

Organization Active NPI

Royal Wa Lacey LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Lacey, WA
National Provider Identifier
1336890854
Registry record updated Mar 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
ROYAL WA LACEY LLC
Practice address
8645 Martin Way E
Lacey, WA 98516-5851
Phone
(855) 468-3369
NPI assigned
Jan 17, 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
Compliance Manager
Phone
(561) 562-6271

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

8645 Martin Way E
Lacey, WA 98516-5851

Mailing address

1590 S Congress Ave
Palm Springs, FL 33406-5957
Phone (347) 693-4239

Other names 1

  • Royal Life Centers Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Royal Life Centers2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1642377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647907200000",
    "number": "1336890854",
    "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": "347-693-4239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8645 MARTIN WAY E",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985165851",
            "telephone_number": "855-468-3369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROYAL WA LACEY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-17",
        "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": "COMPLIANCE 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": 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 Lacey, WA

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.