Organization
MSHC COLONIAL LODGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLA POWER (CFO)
(903) 534-8667
Entity
Organization
Contact information
Practice address
5001 ELIZABETH ST, TEXARKANA, TX 75503-2913
(903) 792-0838
(903) 793-4562
Mailing address
1901 RICKETY LN, STE 208, TYLER, TX 75703-1702
(903) 534-8667
(903) 509-0026
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
114502
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010136550
CBA CONTRACT
TX
Enumeration date
12/27/2006
Last updated
08/22/2020
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