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General NPI Number Information
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NPI Number | 1487980082
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Entity Type | Organization
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Legal Business Name | COLONIAL GROUP LLC
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Dates
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Enumeration Date | 11/02/2009
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Last Update Date | 11/02/2009
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Provider Practice Location Address
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Address Line | 5430 W US HIGHWAY 40
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City | GREENFIELD
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State | IN
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Zip | 46140-8803
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Country | US
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Telephone | 317-894-3301
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Fax | 317-254-2510
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Provider Business Mailing Address
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Address Line | 5430 W US HIGHWAY 40
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City | GREENFIELD
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State | IN
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Zip | 46140-8803
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Country | US
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Telephone | 317-894-3301
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Fax | 317-254-2510
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Authorized Official
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Title or Position | CONTROLLER
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Name | MRS. CYNTHIA RENE ROTH
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Credential |
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Telephone | 317-557-1190
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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 | 09-000360-1
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License Number State | IN
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