Organization
ROYAL AZ LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANDALEE JACKSON (CREDENTIALING MANAGER)
(561) 562-6271
Entity
Organization
Contact information
Practice address
818 W GURLEY ST, PRESCOTT, AZ 86305-3624
(855) 468-3369
Mailing address
1590 S CONGRESS AVE, PALM SPRINGS, FL 33406-5957
(347) 693-4239
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
01/17/2022
Last updated
03/22/2022
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