Healthcare Provider Details

I. General information

NPI: 1447307699
Provider Name (Legal Business Name): COLONIAL HOUSE OF FESTUS II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 GRAY ST
FESTUS MO
63028-1950
US

IV. Provider business mailing address

PO BOX 758
FESTUS MO
63028-0758
US

V. Phone/Fax

Practice location:
  • Phone: 636-933-4050
  • Fax: 636-937-9550
Mailing address:
  • Phone: 636-933-4050
  • Fax: 636-937-9550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: MR. GREG A SAUER
Title or Position: OFFICE MANAGER
Credential:
Phone: 636-933-4911