Provider Demographics
NPI:1942039607
Name:ROYAL OAK HEALTHCARE
Entity type:Organization
Organization Name:ROYAL OAK HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN, FNP-C
Authorized Official - Phone:970-412-2395
Mailing Address - Street 1:1151 EAGLE DR # 311
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-8020
Mailing Address - Country:US
Mailing Address - Phone:970-412-2395
Mailing Address - Fax:
Practice Address - Street 1:1332 LINDEN ST STE 1
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3289
Practice Address - Country:US
Practice Address - Phone:720-600-4637
Practice Address - Fax:720-815-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty