Healthcare Provider Details

I. General information

NPI: 1295010221
Provider Name (Legal Business Name): COLONY HOUSE FURNITURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2011
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 FRONT ST
LYNDEN WA
98264-1920
US

IV. Provider business mailing address

411 FRONT ST
LYNDEN WA
98264-1920
US

V. Phone/Fax

Practice location:
  • Phone: 360-354-5554
  • Fax: 360-354-5554
Mailing address:
  • Phone: 360-354-5554
  • Fax: 360-354-5554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY LEE BODE
Title or Position: OWNER
Credential:
Phone: 260-354-5554