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General NPI Number Information
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NPI Number | 1417526674
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Entity Type | Organization
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Legal Business Name | COLONIAL SKILLED NURSING FACILITY, LLC
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Dates
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Enumeration Date | 06/22/2021
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 2090 N CONGRESS AVE
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-8210
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Country | US
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Telephone | 561-214-4997
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Fax |
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Provider Business Mailing Address
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Address Line | 411 WALNUT ST
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-3443
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Country | US
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Telephone | 305-469-1600
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | RICKI KANETI
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Credential |
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Telephone | 954-600-6333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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