Organization
COLONIAL LONG TERM CARE FACILITY, INC
Active
Other names
Colonial Care, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MARK A. PAYNE (ADMINISTRATOR)
(336) 786-2194
Entity
Organization
Contact information
Practice address
340 SNOWHILL DR, MOUNT AIRY, NC 27030-4394
(336) 786-2194
(336) 786-8891
Mailing address
340 SNOWHILL DR, MOUNT AIRY, NC 27030-4394
(336) 786-2194
(336) 786-8891
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
HAL-086-002
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7801494
—
NC
Enumeration date
01/18/2007
Last updated
08/20/2010
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