Provider Demographics
NPI:1639398654
Name:COLONIAL INN, LLC
Entity Type:Organization
Organization Name:COLONIAL INN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:SCHEMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-499-9656
Mailing Address - Street 1:14565 SIMS RD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8549
Mailing Address - Country:US
Mailing Address - Phone:561-499-2300
Mailing Address - Fax:
Practice Address - Street 1:5861 HERITAGE PARK WAY
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8554
Practice Address - Country:US
Practice Address - Phone:561-499-9656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5173310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility