Healthcare Provider Details

I. General information

NPI: 1700564333
Provider Name (Legal Business Name): COLUMBIA MANOR HEALTH & REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 E NIFONG BLVD
COLUMBIA MO
65201-3874
US

IV. Provider business mailing address

2012 E NIFONG BLVD
COLUMBIA MO
65201-3874
US

V. Phone/Fax

Practice location:
  • Phone: 573-449-1246
  • Fax: 573-874-8753
Mailing address:
  • Phone: 573-449-1246
  • 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: CHAIM MANDELBAUM
Title or Position: MANAGER
Credential:
Phone: 573-449-1246