Provider Demographics
NPI:1366283988
Name:ROYAL LEGACY EMPIRE LLC
Entity type:Organization
Organization Name:ROYAL LEGACY EMPIRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ADDICTION COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JENA'
Authorized Official - Middle Name:CARMALETA
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, LAC, AADC
Authorized Official - Phone:225-206-4064
Mailing Address - Street 1:12500 OLD HAMMOND HWY APT G2
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-1091
Mailing Address - Country:US
Mailing Address - Phone:225-206-4064
Mailing Address - Fax:
Practice Address - Street 1:4581 PEERLESS ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70811-5430
Practice Address - Country:US
Practice Address - Phone:225-206-4064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-06
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty