Provider Demographics
NPI:1417526674
Name:COLONIAL SKILLED NURSING FACILITY, LLC
Entity Type:Organization
Organization Name:COLONIAL SKILLED NURSING FACILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:KANETI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-600-6333
Mailing Address - Street 1:1280 HARBOR CT
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-5030
Mailing Address - Country:US
Mailing Address - Phone:305-469-1600
Mailing Address - Fax:
Practice Address - Street 1:2090 N CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-8210
Practice Address - Country:US
Practice Address - Phone:561-214-4997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility