Provider Demographics
NPI:1982779724
Name:COLONIAL MANORS OF COLUMBUS COMMUNITY INC
Entity Type:Organization
Organization Name:COLONIAL MANORS OF COLUMBUS COMMUNITY INC
Other - Org Name:COLONIAL MANORS OF COLUMBUS COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SENTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-728-2276
Mailing Address - Street 1:814 SPRINGER AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS JUNCTION
Mailing Address - State:IA
Mailing Address - Zip Code:52738-1305
Mailing Address - Country:US
Mailing Address - Phone:319-728-2276
Mailing Address - Fax:319-728-8998
Practice Address - Street 1:814 SPRINGER AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS JUNCTION
Practice Address - State:IA
Practice Address - Zip Code:52738-1305
Practice Address - Country:US
Practice Address - Phone:319-728-2276
Practice Address - Fax:319-728-8998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
IA580135314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA65476OtherBCBS PROVIDER #
IA0809061Medicaid
IA165476Medicare Oscar/Certification