# COLONIAL TERRACE INTERMEDIATE CARE, INC.

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

## Provider details

- **NPI number:** 1992790802
- **Authorized official:** MR. TERRY LYNN SKAGGS (CFO)
- **Authorized official phone:** (270) 926-9355

## Contact information

- **Practice address:** 142 ROGER POWELL RD, SEBREE, KY 42455-2115
- **Practice address phone:** (270) 835-2533
- **Practice address fax:** (270) 853-9004
- **Mailing address:** 725 HARVARD DR, OWENSBORO, KY 42301-6185
- **Mailing address phone:** (270) 926-9355
- **Mailing address fax:** (270) 684-6283

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 100440 | KY | Yes |
| 332BP3500X | Parenteral & Enteral Nutrition Supplies (DME) | 100440 | KY | — |

## Other

- **Enumeration date:** 09/16/2005
- **Last updated:** 04/16/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 12501789 | — | KY |