Healthcare Provider Details

I. General information

NPI: 1285824797
Provider Name (Legal Business Name): COLBY OPERATOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E. COLLEGE DR.
COLBY KS
67701-3701
US

IV. Provider business mailing address

105 E. COLLEGE DR.
COLBY KS
67701-3701
US

V. Phone/Fax

Practice location:
  • Phone: 785-462-6721
  • Fax: 785-460-2136
Mailing address:
  • Phone: 785-462-6721
  • Fax: 785-460-2136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN097002
License Number StateKS

VIII. Authorized Official

Name: MR. STUART LINDEMAN
Title or Position: CEO
Credential:
Phone: 813-440-8345