Provider Demographics
NPI:1457358426
Name:COLONIAL MANOR
Entity Type:Organization
Organization Name:COLONIAL MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SNOWBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-994-4191
Mailing Address - Street 1:747 S MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44842-1416
Mailing Address - Country:US
Mailing Address - Phone:419-994-4191
Mailing Address - Fax:419-994-3756
Practice Address - Street 1:747 S MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:OH
Practice Address - Zip Code:44842-1416
Practice Address - Country:US
Practice Address - Phone:419-994-4191
Practice Address - Fax:419-994-3756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2482313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility