Organization
COLONIAL CLUB, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELODY RIEDEL (EXECUTIVE DIRECTOR)
(608) 837-4611
Entity
Organization
Contact information
Practice address
301 BLANKENHEIM LN, SUN PRAIRIE, WI 53590-2373
(608) 837-4611
(608) 837-9302
Mailing address
301 BLANKENHEIM LN, SUN PRAIRIE, WI 53590-2373
(608) 837-4611
(608) 837-9302
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
265-800
WI
261QA0600X
Adult Day Care Clinic/Center
—
—
Other
Enumeration date
03/01/2017
Last updated
04/17/2025
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