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General NPI Number Information
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NPI Number | 1538264015
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Entity Type | Organization
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Legal Business Name | COLUMBIA MANOR, INC.
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 11/23/2016
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Provider Practice Location Address
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Address Line | 2012 E NIFONG BLVD
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City | COLUMBIA
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State | MO
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Zip | 65201-3874
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Country | US
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Telephone | 573-449-1246
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Fax | 573-874-8753
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Provider Business Mailing Address
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Address Line | 2012 E NIFONG BLVD
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City | COLUMBIA
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State | MO
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Zip | 65201-3874
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Country | US
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Telephone | 573-449-1246
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Fax | 573-874-8753
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Authorized Official
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Title or Position | CEO
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Name | BENJAMIN C. SCHEULEN
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Credential |
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Telephone | 573-556-6240
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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 | 015988
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License Number State | MO
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