Basic Information
| Provider Information | |||||||||
| NPI: | 1245566736 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLONIAL MANOR SNF LLC | ||||||||
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| OtherOrganizationName: | COLONIAL MANOR ADVANCED REHAB & HEALTHCARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2121 AVENUE J | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760065887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8176077400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 W MINNESOTA RD | ||||||||
| Address2: | |||||||||
| City: | PHARR | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566862243 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2009 | ||||||||
| LastUpdateDate: | 10/26/2016 | ||||||||
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| AuthorizedOfficialLastName: | SCHEINER | ||||||||
| AuthorizedOfficialFirstName: | ELIEZER | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 9173709063 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BN1400X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Nursing Facility Supplies | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.