Provider Demographics
NPI:1417369760
Name:COLONIAL HEALTHCARE LLC
Entity Type:Organization
Organization Name:COLONIAL HEALTHCARE LLC
Other - Org Name:TRANQUILITY OF ROCKFORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:828-381-4923
Mailing Address - Street 1:308 4TH ST NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-4920
Mailing Address - Country:US
Mailing Address - Phone:828-381-4923
Mailing Address - Fax:
Practice Address - Street 1:203 BUCKEYE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:OH
Practice Address - Zip Code:45882-9266
Practice Address - Country:US
Practice Address - Phone:419-363-2192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility