Provider Demographics
NPI:1548874951
Name:COLONNADE SENIOR DEVELOPMENT, LLC
Entity type:Organization
Organization Name:COLONNADE SENIOR DEVELOPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-705-9397
Mailing Address - Street 1:700 WEBER RD
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2215
Mailing Address - Country:US
Mailing Address - Phone:618-624-6000
Mailing Address - Fax:
Practice Address - Street 1:700 WEBER RD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-2215
Practice Address - Country:US
Practice Address - Phone:618-624-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility