# COLONIAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Colonial Nursing Home
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487980082
- **Authorized official:** MRS. CYNTHIA RENE ROTH (CONTROLLER)
- **Authorized official phone:** (317) 557-1190

## Contact information

- **Practice address:** 5430 W US HIGHWAY 40, GREENFIELD, IN 46140-8803
- **Practice address phone:** (317) 894-3301
- **Practice address fax:** (317) 254-2510
- **Mailing address:** 5430 W US HIGHWAY 40, GREENFIELD, IN 46140-8803
- **Mailing address phone:** (317) 894-3301
- **Mailing address fax:** (317) 254-2510

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 09-000360-1 | IN | Yes |

## Other

- **Enumeration date:** 11/02/2009
- **Last updated:** 11/02/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100290370 | — | IN |