Organization
COLONIAL MANOR, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA K MOORE (PRESIDENT)
(618) 596-6635
Entity
Organization
Contact information
Practice address
300 CHURCH ST, ZEIGLER, IL 62999-1043
(618) 596-6635
(618) 984-7734
Mailing address
300 CHURCH ST, ZEIGLER, IL 62999-1043
(618) 596-6635
(618) 984-7734
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
0044610
IL
Other
Enumeration date
03/16/2010
Last updated
03/16/2010
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