Provider Demographics
NPI:1376535286
Name:COLONIAL SENIOR SERVICES, INC.
Entity Type:Organization
Organization Name:COLONIAL SENIOR SERVICES, INC.
Other - Org Name:BERKELEY SQUARE RETIREMENT COMMUNITY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:ZOELLNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-785-4742
Mailing Address - Street 1:50 BERKELEY DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013
Mailing Address - Country:US
Mailing Address - Phone:513-856-8600
Mailing Address - Fax:513-856-8324
Practice Address - Street 1:50 BERKELEY DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013
Practice Address - Country:US
Practice Address - Phone:513-856-8600
Practice Address - Fax:513-856-8324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5112314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2993560Medicaid
OH2993560Medicaid