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Colonial Manor Llc
Intellectual and/or Developmental Disabilities Residential Treatment Facility in Sikeston, Missouri
NPI 1437219508

Colonial Manor Llc is a Intellectual and/or Developmental Disabilities Residential Treatment Facility based in Sikeston, MO. Colonial Manor Llc practices in Sikeston, MO. The NPI Number for Colonial Manor Llc is 1437219508 and holds a License No. 320600000X (Missouri).

The current practice location address for Colonial Manor Llc is 907 W Malone Ave, Sikeston, MO and can be reached out via phone at 573-471-5541 and via fax at 573-471-3063.

Location: 907 W Malone Ave, Sikeston, MO, 63801-2425
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1437219508
Provider Name
Colonial Manor Llc
Credential
Provider Entity Type
Organization
Address
907 W Malone Ave, Sikeston, MO, 63801-2425
Phone Number
573-471-5541
Fax Number
573-471-3063
Provider Enumeration Date
12/11/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
266744804 05 MO
institution
Provider Business Practice Location Address Details
Address
907 W Malone Ave
City
Sikeston
State
Missouri
Zip
63801-2425
Phone Number
573-471-5541
Fax Number
573-471-3063
person
Provider Business Mailing Address Details
Address
907 W Malone Ave
City
Sikeston
State
Missouri
Zip
63801-2425
Phone Number
573-471-5541
Fax Number
573-471-3063
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320600000X
License No.
320600000X (Missouri)
Definition
A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.
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