Provider Demographics
NPI:1417001488
Name:COLONY HOMES, INC
Entity Type:Organization
Organization Name:COLONY HOMES, INC
Other - Org Name:COLONY HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:VALCIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-426-4393
Mailing Address - Street 1:213 NW LORNA ST
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-4109
Mailing Address - Country:US
Mailing Address - Phone:817-426-4393
Mailing Address - Fax:817-426-4349
Practice Address - Street 1:213 NW LORNA ST
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-4109
Practice Address - Country:US
Practice Address - Phone:817-426-4393
Practice Address - Fax:817-426-4349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007484251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179024801Medicaid
TX179024801Medicaid