Provider Demographics
NPI:1134112147
Name:COLONIAL MANOR OF AMANA INC
Entity Type:Organization
Organization Name:COLONIAL MANOR OF AMANA INC
Other - Org Name:COLONIAL MANOR OF AMANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-626-4710
Mailing Address - Street 1:3207 220TH TRL
Mailing Address - Street 2:
Mailing Address - City:AMANA
Mailing Address - State:IA
Mailing Address - Zip Code:52203-8206
Mailing Address - Country:US
Mailing Address - Phone:319-622-3131
Mailing Address - Fax:319-622-6458
Practice Address - Street 1:3207 220TH TRL
Practice Address - Street 2:
Practice Address - City:AMANA
Practice Address - State:IA
Practice Address - Zip Code:52203-8206
Practice Address - Country:US
Practice Address - Phone:319-622-3131
Practice Address - Fax:319-622-6458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA480217261QP2000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0800656Medicaid
IA165318Medicare Oscar/Certification