Provider Demographics
NPI:1841738143
Name:COLONIAL 365, INC.
Entity Type:Organization
Organization Name:COLONIAL 365, INC.
Other - Org Name:COLONIAL TRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARON
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:WOOTTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-990-9380
Mailing Address - Street 1:500 N FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1456
Mailing Address - Country:US
Mailing Address - Phone:517-990-9380
Mailing Address - Fax:517-782-7303
Practice Address - Street 1:500 N FRANCIS ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1456
Practice Address - Country:US
Practice Address - Phone:517-990-9380
Practice Address - Fax:517-782-7303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3134343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)