Provider Demographics
NPI:1770038366
Name:RIPLEY COUNTY COLONIAL HOME, INC
Entity Type:Organization
Organization Name:RIPLEY COUNTY COLONIAL HOME, INC
Other - Org Name:COLONIAL HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WADE
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:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1871613174Medicaid
MO1508987546Medicaid
MO288016900Medicaid
MO1144341181Medicaid