Organization
COLONIAL VILLAGE LV PROPERTY, LTD
Active
Other names
Colonial Village
Organization subpart
No
Provider details
NPI number
Authorized official
JON HARDER (MEDICAID COORDINATOR)
(903) 758-6332
Entity
Organization
Contact information
Practice address
2910 N EASTMAN RD, LONGVIEW, TX 75605-5029
(903) 758-6332
Mailing address
3723 FAIRVIEW INDUSTRIAL DR SE, SUITE 270, SALEM, OR 97302-1177
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
04/22/2007
Last updated
08/22/2020
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