Organization
ROYALTY PERSONAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON WILLIAMS SIMMONS (PROGRAM ADMINISTRATOR)
(225) 803-8217
Entity
Organization
Contact information
Practice address
1532 S BURNSIDE AVE BLDG 10A, GONZALES, LA 70737-4444
(225) 677-9769
(225) 313-3488
Mailing address
1532 SOUTH BURNSIDE AVE.SUITE 10 A, GONZALES, LA 70707
(225) 677-9769
(225) 313-3488
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
PCA 14063
LA
Other
Enumeration date
12/24/2007
Last updated
12/24/2007
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