Provider Demographics
NPI:1881828424
Name:THE COLONNADES GROUP HOME, INC
Entity type:Organization
Organization Name:THE COLONNADES GROUP HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:STROTHER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:561-541-1604
Mailing Address - Street 1:1962 SW MCALLISTER LN
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2063
Mailing Address - Country:US
Mailing Address - Phone:561-541-1604
Mailing Address - Fax:772-204-2341
Practice Address - Street 1:1962 SW MCALLISTER LN
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2063
Practice Address - Country:US
Practice Address - Phone:561-541-1604
Practice Address - Fax:772-204-2341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home