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General NPI Number Information
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NPI Number | 1841738143
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Entity Type | Organization
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Legal Business Name | COLONIAL 365, INC.
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 500 N FRANCIS ST
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City | JACKSON
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State | MI
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Zip | 49201-1456
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Country | US
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Telephone | 517-990-9380
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Fax | 517-782-7303
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Provider Business Mailing Address
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Address Line | 500 N FRANCIS ST
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City | JACKSON
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State | MI
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Zip | 49201-1456
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Country | US
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Telephone | 517-990-9380
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Fax | 517-782-7303
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | CARON MARIA WOOTTEN
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Credential |
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Telephone | 517-990-9380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 3134
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License Number State | MI
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