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Organization
COLONIAL TERRACE INTERMEDIATE CARE, INC.
Active
Organization
COLONIAL TERRACE INTERMEDIATE CARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRY LYNN SKAGGS (CFO)
(270) 926-9355
Entity
Organization
Contact information
Practice address
142 ROGER POWELL RD, SEBREE, KY 42455-2115
(270) 835-2533
(270) 853-9004
Mailing address
725 HARVARD DR, OWENSBORO, KY 42301-6185
(270) 926-9355
(270) 684-6283
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
100440
KY
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
100440
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12501789
—
KY
Enumeration date
09/16/2005
Last updated
04/16/2008
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