Colonial Manor LLC

NPI #1437219508 in Sikeston, Missouri

Provider Information

NPI Number: 1437219508
Entity Type: Organization
Organization Name: Colonial Manor LLC
Primary Specialty: Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Dec 11, 2006
Last Updated: Jun 16, 2008

Practice Location

Address: 907 W MALONE AVE
City: Sikeston
State: Missouri
ZIP Code: 63801-2425
Phone: (573) 471-5541

Authorized Official

Name: LINDA F ATCHLEY
Title: OPERATOR
Phone: (573) 471-5541

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320600000X	Primary

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