Provider Demographics
NPI:1326382821
Name:COLONY DRUG & WELLNESS CENTER DSME
Entity Type:Organization
Organization Name:COLONY DRUG & WELLNESS CENTER DSME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD, CDE
Authorized Official - Phone:304-252-5305
Mailing Address - Street 1:2810 ROBERT C BYRD DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-5238
Mailing Address - Country:US
Mailing Address - Phone:304-252-5305
Mailing Address - Fax:304-253-4281
Practice Address - Street 1:2810 ROBERT C BYRD DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-5238
Practice Address - Country:US
Practice Address - Phone:304-252-5305
Practice Address - Fax:304-253-4281
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHNSTON & JOHNSTON, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center