MEDICARE: COLONIAL MANOR

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	313M00000X	Nursing Facility/Intermediate Care Facility	2482	OH

General Provider Information

NPI Number	:	1457358426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLONIAL MANOR

Provider Business Mailing Address
First Line	:	747 S MOUNT VERNON AVE
Second Line	:
City	:	LOUDONVILLE
State	:	OH
Zip	:	44842-1416
Country	:	US
Telephone Number	:	419-994-4191
Fax Number	:	419-994-3756

Provider Business Practice Location Address
First Line	:	747 S MOUNT VERNON AVE
Second Line	:
City	:	LOUDONVILLE
State	:	OH
Zip	:	44842-1416
Country	:	US
Telephone Number	:	419-994-4191
Fax Number	:	419-994-3756

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MR. LINDA SUE SNOWBARGER
Credential	:
Telephone Number	:	419-994-4191

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	08/22/2020

Similar Medicare Providers

1386639078 — COLONIAL MANOR HEALTH CARE CENTER, INC.
Practice Location Address:

747 S MOUNT VERNON AVE
LOUDONVILLE, OH
44842-1416

Practice Phone: 419-994-4191
Practice Fax:

1205786365 — INCREASED BEHAVIOR ALTERNATIVES SUPPORT SERVICES, LLC
Practice Location Address:

695 S MOUNT VERNON AVE
LOUDONVILLE, OH
44842-1414

Practice Phone: 419-299-4229
Practice Fax: 614-430-9622

1598761371 — DR. ROBERT D. BERRY D.C.
Practice Location Address:

2863 COUNTY ROAD 529
LOUDONVILLE, OH
44842-9202

Practice Phone: 419-994-5551
Practice Fax: 419-994-5552

1336146604 — DR. RICHARD M. GARDNER D.C.
Practice Location Address:

2863 COUNTY ROAD 529
LOUDONVILLE, OH
44842-9202

Practice Phone: 419-994-5551
Practice Fax: 419-994-5552

1790771160 — DR. TERESA T COOPERRIDER O.D.
Practice Location Address:

637 N UNION ST
LOUDONVILLE, OH
44842-1074

Practice Phone: 419-994-4287
Practice Fax: 419-994-2612

1659355196 — MR. ROGER BICKHART RPH
Practice Location Address:

202 W MAIN ST
LOUDONVILLE, OH
44842-1134

Practice Phone: 419-994-3221
Practice Fax: 419-994-4040

Directions to “COLONIAL MANOR ” Practice Location

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