Organization
COLONIAL GROUP LLC
Active
Other names
Colonial Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CYNTHIA RENE ROTH (CONTROLLER)
(317) 557-1190
Entity
Organization
Contact information
Practice address
5430 W US HIGHWAY 40, GREENFIELD, IN 46140-8803
(317) 894-3301
(317) 254-2510
Mailing address
5430 W US HIGHWAY 40, GREENFIELD, IN 46140-8803
(317) 894-3301
(317) 254-2510
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
09-000360-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100290370
—
IN
Enumeration date
11/02/2009
Last updated
11/02/2009
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