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NPI Code Detail

MEDICARE: COLONIAL MANOR OPERATING CO., INC.

MEDICARE: COLONIAL MANOR OPERATING CO., 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
1314000000XSkilled Nursing Facility1544NOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11544NOTHEROHNURSING HOME LICENSE #
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790780153
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLONIAL MANOR OPERATING CO., INC.
Provider Business Mailing Address
First Line : 196 COLONIAL DR
Second Line :
City : YOUNGSTOWN
State : OH
Zip : 44505-2139
Country : US
Telephone Number : 330-759-8000
Fax Number : 330-759-4540
Provider Business Practice Location Address
First Line : 196 COLONIAL DR
Second Line :
City : YOUNGSTOWN
State : OH
Zip : 44505-2139
Country : US
Telephone Number : 330-759-8000
Fax Number : 330-759-4540
Authorized Official
Title or Position : PRESIDENT
Name : MR. THOMAS D. NORDQUIST
Credential :
Telephone Number : 330-726-6047
Provider Enumeration Date : 06/14/2005
Last Update Date : 08/22/2020

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