Provider Demographics
NPI:1174519672
Name:COLONIAL MANOR OF COLUMBUS COMMUNITY
Entity type:Organization
Organization Name:COLONIAL MANOR OF COLUMBUS COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIRSCHLING
Authorized Official - Suffix:
Authorized Official - Credentials:CEO/ADMINISTRATOR
Authorized Official - Phone:319-728-2276
Mailing Address - Street 1:814 SPRINGER AVE
Mailing Address - Street 2:P.O. BOX 266
Mailing Address - City:COLUMBUS JUNCTION
Mailing Address - State:IA
Mailing Address - Zip Code:52738-1305
Mailing Address - Country:US
Mailing Address - Phone:319-728-2276
Mailing Address - Fax:319-728-8998
Practice Address - Street 1:814 SPRINGER AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS JUNCTION
Practice Address - State:IA
Practice Address - Zip Code:52738-1305
Practice Address - Country:US
Practice Address - Phone:319-728-2276
Practice Address - Fax:319-728-8998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0809061Medicaid
IA165476Medicare ID - Type Unspecified