Provider Demographics
NPI:1548376882
Name:COLONIAL MANORS OF MANILLA INC
Entity type:Organization
Organization Name:COLONIAL MANORS OF MANILLA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIXIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-654-6812
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:MANILLA
Mailing Address - State:IA
Mailing Address - Zip Code:51454-7706
Mailing Address - Country:US
Mailing Address - Phone:712-654-6812
Mailing Address - Fax:712-654-6800
Practice Address - Street 1:146 NORTH 5TH STREET
Practice Address - Street 2:
Practice Address - City:MANILLA
Practice Address - State:IA
Practice Address - Zip Code:51454-7706
Practice Address - Country:US
Practice Address - Phone:712-654-6812
Practice Address - Fax:712-654-6800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA240486314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0802405Medicaid
IA0802405Medicaid