Healthcare Provider Details

I. General information

NPI: 1285636910
Provider Name (Legal Business Name): COLONIAL MANOR OF ELMA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 9TH ST
ELMA IA
50628-8217
US

IV. Provider business mailing address

1320 4TH ST NE
HAMPTON IA
50441-1104
US

V. Phone/Fax

Practice location:
  • Phone: 641-393-2134
  • Fax: 641-393-2004
Mailing address:
  • Phone: 641-456-5636
  • Fax: 641-456-2320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number450794
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. TIMOTHY ROBERTS
Title or Position: CFO
Credential:
Phone: 641-456-5636