Provider Demographics
NPI:1447307699
Name:COLONIAL HOUSE OF FESTUS II
Entity type:Organization
Organization Name:COLONIAL HOUSE OF FESTUS II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-933-4911
Mailing Address - Street 1:PO BOX 758
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-0758
Mailing Address - Country:US
Mailing Address - Phone:636-933-4050
Mailing Address - Fax:636-937-9550
Practice Address - Street 1:129 GRAY ST
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-1950
Practice Address - Country:US
Practice Address - Phone:636-933-4050
Practice Address - Fax:636-937-9550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO266758200Medicaid