Healthcare Provider Details

I. General information

NPI: 1992790075
Provider Name (Legal Business Name): OCOEE COLBY HEALTHCARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 W DOLF ST
COLBY WI
54421-9604
US

IV. Provider business mailing address

3915 ADKISSON DR NW
CLEVELAND TN
37312-2821
US

V. Phone/Fax

Practice location:
  • Phone: 715-223-2352
  • Fax: 859-281-5150
Mailing address:
  • Phone: 423-834-3188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3080
License Number StateWI

VIII. Authorized Official

Name: JOHN SHEEHAN
Title or Position: MEMBER
Credential:
Phone: 423-618-1488