# MOBILEMOGULRURALHEALTHCLINIC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ROYALRESPITE
- **Other names:** RoyalRespite
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1659190700
- **Legal business name:** ROYALRESPITE
- **Authorized official:** DORIS V WALKER CDCP (ADMINISTRATOR)
- **Authorized official phone:** (262) 504-0241

## Contact information

- **Practice address:** 35236 N WILSON RD, INGLESIDE, IL 60041
- **Practice address phone:** (262) 504-0241
- **Mailing address:** PO BOX 70, FAIRFIELD, CA 94533-0006

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106S00000X | Behavior Technician | — | NULL | — |
| 106S00000X | Behavior Technician | — | — | — |
| 133NN1002X | Nutrition Education Nutritionist | — | NULL | — |
| 133NN1002X | Nutrition Education Nutritionist | — | — | — |
| 136A00000X | Registered Dietetic Technician | — | NULL | — |
| 136A00000X | Registered Dietetic Technician | — | — | — |
| 174200000X | Meals Provider | — | NULL | — |
| 251E00000X | Home Health Agency | — | NULL | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |
| 344600000X | Taxi | — | NULL | — |
| 374U00000X | Home Health Aide | — | NULL | — |
| 374U00000X | Home Health Aide | — | — | — |
| 385H00000X | Respite Care | — | NULL | — |
| 385HR2060X | Child Intellectual and/or Developmental Disabilities Respite Care | — | NULL | — |

## Other

- **Enumeration date:** 10/07/2024
- **Last updated:** 10/07/2024