Organization
ROYALTY CDS AGENCY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAKISHA MCCOMB (OWNER)
(314) 706-2543
Entity
Organization
Contact information
Practice address
5379 TRAILOAKS DR, BLACK JACK, MO 63033-4639
(314) 706-2543
Mailing address
5379 TRAILOAKS DR, BLACK JACK, MO 63033-4639
(314) 706-2543
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255851093
—
MO
05
—
LC001544462
—
MO
Enumeration date
07/21/2021
Last updated
07/21/2021
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