Provider Demographics
NPI:1508987546
Name:RIPLEY COUNTY COLONIAL HOME, INC.
Entity Type:Organization
Organization Name:RIPLEY COUNTY COLONIAL HOME, INC.
Other - Org Name:WALNUT STREET
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-996-3328
Mailing Address - Street 1:102 E SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:DONIPHAN
Mailing Address - State:MO
Mailing Address - Zip Code:63935-1328
Mailing Address - Country:US
Mailing Address - Phone:573-996-3328
Mailing Address - Fax:573-996-7274
Practice Address - Street 1:102 E SUMMIT ST
Practice Address - Street 2:
Practice Address - City:DONIPHAN
Practice Address - State:MO
Practice Address - Zip Code:63935-1328
Practice Address - Country:US
Practice Address - Phone:573-996-3328
Practice Address - Fax:573-996-7274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO028930310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility