Provider Demographics
NPI:1902038672
Name:COLONIAL SENIOR LIVING OF WESTERN PA LLC
Entity Type:Organization
Organization Name:COLONIAL SENIOR LIVING OF WESTERN PA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:COLVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-542-9721
Mailing Address - Street 1:909 WEST ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-2833
Mailing Address - Country:US
Mailing Address - Phone:301-542-9721
Mailing Address - Fax:
Practice Address - Street 1:19713 SPRING CREEK RD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2534
Practice Address - Country:US
Practice Address - Phone:301-542-9721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-14
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility