Colonial Club, Inc.

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

License

265-800 Issued in WI

Legal business name

COLONIAL CLUB, INC.

Practice address

301 Blankenheim LN
Sun Prairie, WI 53590-2373

Phone

(608) 837-4611

Fax

(608) 837-9302

NPI assigned

Mar 1, 2017

Last updated

Apr 17, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Melody Riedel

Title

Executive Director

Phone

(608) 837-4611

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1488326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744848000000",
    "number": "1033659669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 BLANKENHEIM LN",
            "city": "SUN PRAIRIE",
            "state": "WI",
            "postal_code": "535902373",
            "telephone_number": "608-837-4611",
            "fax_number": "608-837-9302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 BLANKENHEIM LN",
            "city": "SUN PRAIRIE",
            "state": "WI",
            "postal_code": "535902373",
            "telephone_number": "608-837-4611",
            "fax_number": "608-837-9302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLONIAL CLUB, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-01",
        "last_updated": "2025-04-17",
        "certification_date": "2025-04-17",
        "status": "A",
        "authorized_official_last_name": "RIEDEL",
        "authorized_official_first_name": "MELODY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "608-837-4611"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": "WI",
            "license": "265-800",
            "primary": true
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Voluntary or Charitable Agency in Sun Prairie, WI
• Providers in Sun Prairie, WI by specialty
• Voluntary or Charitable Agency in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.