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General NPI Number Information
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NPI Number | 1457358426
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Entity Type | Organization
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Legal Business Name | COLONIAL MANOR
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Dates
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Enumeration Date | 07/05/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 747 S MOUNT VERNON AVE
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City | LOUDONVILLE
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State | OH
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Zip | 44842-1416
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Country | US
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Telephone | 419-994-4191
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Fax | 419-994-3756
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Provider Business Mailing Address
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Address Line | 747 S MOUNT VERNON AVE
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City | LOUDONVILLE
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State | OH
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Zip | 44842-1416
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Country | US
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Telephone | 419-994-4191
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Fax | 419-994-3756
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MR. LINDA SUE SNOWBARGER
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Credential |
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Telephone | 419-994-4191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 2482
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License Number State | OH
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