# COLONIAL MANOR LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437219508
- **Authorized official:** LINDA F ATCHLEY (OPERATOR)
- **Authorized official phone:** (573) 471-5541

## Contact information

- **Practice address:** 907 W MALONE AVE, SIKESTON, MO 63801-2425
- **Practice address phone:** (573) 471-5541
- **Practice address fax:** (573) 471-3063
- **Mailing address:** 907 W MALONE AVE, SIKESTON, MO 63801-2425
- **Mailing address phone:** (573) 471-5541
- **Mailing address fax:** (573) 471-3063

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 320600000X | MO | Yes |

## Other

- **Enumeration date:** 12/11/2006
- **Last updated:** 06/16/2008