Healthcare Provider Details

I. General information

NPI: 1417526674
Provider Name (Legal Business Name): COLONIAL SKILLED NURSING FACILITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 N CONGRESS AVE
WEST PALM BEACH FL
33401-8210
US

IV. Provider business mailing address

411 WALNUT ST
GREEN COVE SPRINGS FL
32043-3443
US

V. Phone/Fax

Practice location:
  • Phone: 561-214-4997
  • Fax:
Mailing address:
  • Phone: 305-469-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: RICKI KANETI
Title or Position: MANAGING MEMBER
Credential:
Phone: 954-600-6333