Healthcare Provider Details

I. General information

NPI: 1184606048
Provider Name (Legal Business Name): COLONIAL NURSING HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 N WASHINGTON ST
MARKSVILLE LA
71351-2426
US

IV. Provider business mailing address

426 N WASHINGTON ST
MARKSVILLE LA
71351-2426
US

V. Phone/Fax

Practice location:
  • Phone: 318-253-4556
  • Fax: 318-253-4550
Mailing address:
  • Phone: 318-253-4556
  • Fax: 318-253-4550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number51
License Number StateLA

VIII. Authorized Official

Name: MR. MELVIN J HARRIS
Title or Position: OWNER CEO
Credential:
Phone: 318-253-6536