Provider Demographics
NPI:1851917538
Name:COLONIAL HOME CARE
Entity Type:Organization
Organization Name:COLONIAL HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:RENFROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-753-5258
Mailing Address - Street 1:27680 FRANKLIN RD # B
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-8203
Mailing Address - Country:US
Mailing Address - Phone:248-770-3116
Mailing Address - Fax:248-281-1810
Practice Address - Street 1:27680 FRANKLIN RD # B
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-8203
Practice Address - Country:US
Practice Address - Phone:248-770-3116
Practice Address - Fax:248-281-1810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)