MEDICARE: COLONIAL NURSING HOME INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	51	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	19003014Z	OTHER	LA	BCBS

General Provider Information

NPI Number	:	1184606048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLONIAL NURSING HOME INC

Provider Business Mailing Address
First Line	:	426 N WASHINGTON ST
Second Line	:
City	:	MARKSVILLE
State	:	LA
Zip	:	71351-2426
Country	:	US
Telephone Number	:	318-253-4556
Fax Number	:	318-253-4550

Provider Business Practice Location Address
First Line	:	426 N WASHINGTON ST
Second Line	:
City	:	MARKSVILLE
State	:	LA
Zip	:	71351-2426
Country	:	US
Telephone Number	:	318-253-4556
Fax Number	:	318-253-4550

Authorized Official
Title or Position	:	OWNER CEO
Name	:	MR. MELVIN J HARRIS
Credential	:
Telephone Number	:	318-253-6536

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	04/20/2008

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