Basic Information
| Provider Information | |||||||||
| NPI: | 1548874951 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLONNADE SENIOR DEVELOPMENT, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 WEBER RD | ||||||||
| Address2: | |||||||||
| City: | O FALLON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622692215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186246000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 WEBER RD | ||||||||
| Address2: | |||||||||
| City: | O FALLON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622692215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186246000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2020 | ||||||||
| LastUpdateDate: | 09/02/2020 | ||||||||
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| AuthorizedOfficialLastName: | LEVEY | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 2137059397 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 09/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.