Organization
COLONIAL MANOR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA F ATCHLEY (OPERATOR)
(573) 471-5541
Entity
Organization
Contact information
Practice address
907 W MALONE AVE, SIKESTON, MO 63801-2425
(573) 471-5541
(573) 471-3063
Mailing address
907 W MALONE AVE, SIKESTON, MO 63801-2425
(573) 471-5541
(573) 471-3063
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
320600000X
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
266744804
—
MO
Enumeration date
12/11/2006
Last updated
06/16/2008
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