Provider Demographics
NPI:1285824797
Name:COLBY OPERATOR, LLC
Entity Type:Organization
Organization Name:COLBY OPERATOR, LLC
Other - Org Name:COLBY HEALTH AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-440-8345
Mailing Address - Street 1:105 E. COLLEGE DR.
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-3701
Mailing Address - Country:US
Mailing Address - Phone:785-462-6721
Mailing Address - Fax:785-460-2136
Practice Address - Street 1:105 E. COLLEGE DR.
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701-3701
Practice Address - Country:US
Practice Address - Phone:785-462-6721
Practice Address - Fax:785-460-2136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN097002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200438930BMedicaid
KS200346960AMedicaid
KS200438930BMedicaid