Provider Demographics
NPI:1831379114
Name:COLONIAL HOUSE OF FESTUS I
Entity type:Organization
Organization Name:COLONIAL HOUSE OF FESTUS I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALYSHA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-933-4911
Mailing Address - Street 1:115 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-1733
Mailing Address - Country:US
Mailing Address - Phone:636-933-4911
Mailing Address - Fax:636-933-9550
Practice Address - Street 1:500 SUNSHINE DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-1645
Practice Address - Country:US
Practice Address - Phone:636-937-4050
Practice Address - Fax:636-933-2513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness