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General NPI Number Information
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NPI Number | 1831379114
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Entity Type | Organization
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Legal Business Name | COLONIAL HOUSE OF FESTUS I
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 11/05/2007
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Provider Practice Location Address
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Address Line | 500 SUNSHINE DR
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City | FESTUS
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State | MO
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Zip | 63028-1645
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Country | US
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Telephone | 636-937-4050
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Fax | 636-933-2513
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Provider Business Mailing Address
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Address Line | 115 WEST AVE
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City | FESTUS
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State | MO
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Zip | 63028-1733
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Country | US
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Telephone | 636-933-4911
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Fax | 636-933-9550
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ALYSHA LYNN SAUER
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Credential |
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Telephone | 636-933-4911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State | MO
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