Healthcare Provider Details

I. General information

NPI: 1417369760
Provider Name (Legal Business Name): COLONIAL HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 BUCKEYE ST
ROCKFORD OH
45882-9266
US

IV. Provider business mailing address

308 4TH ST NW
HICKORY NC
28601-4920
US

V. Phone/Fax

Practice location:
  • Phone: 419-363-2192
  • Fax:
Mailing address:
  • Phone: 828-381-4923
  • 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: MR. MELVIN EUGENE WOODWARD JR.
Title or Position: CEO
Credential:
Phone: 828-381-4923