Provider Demographics
NPI:1295010221
Name:COLONY HOUSE FURNITURE
Entity Type:Organization
Organization Name:COLONY HOUSE FURNITURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BODE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-354-5554
Mailing Address - Street 1:411 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-1920
Mailing Address - Country:US
Mailing Address - Phone:360-354-5554
Mailing Address - Fax:360-354-5554
Practice Address - Street 1:411 FRONT ST
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1920
Practice Address - Country:US
Practice Address - Phone:360-354-5554
Practice Address - Fax:360-354-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment