NPIMap

Organization Active NPI

Stellbrook Management, LLC

Doing business as The Colonial Home

  • Assisted Living Facility
  • Doniphan, MO
National Provider Identifier
1033873088
Registry record updated Nov 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
STELLBROOK MANAGEMENT, LLC
Doing business as
The Colonial Home
Practice address
102 E Summit St
Doniphan, MO 63935-1328
Phone
(573) 712-2992
NPI assigned
Oct 26, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2021

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

Authorized official

Name
Jacob Hogg
Title
Administrator
Phone
(573) 712-2992

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X Primary

Addresses

Primary practice location

102 E Summit St
Doniphan, MO 63935-1328

Mailing address

1321 W Maud St
Poplar Bluff, MO 63901-4819
Phone (157) 371-2299

Other names 1

  • The Colonial Home Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Stellbrook Management LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1635206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638057600000",
    "number": "1033873088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1321 W MAUD ST",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639014819",
            "telephone_number": "157-371-2299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 E SUMMIT ST",
            "city": "DONIPHAN",
            "state": "MO",
            "postal_code": "639351328",
            "telephone_number": "573-712-2992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STELLBROOK MANAGEMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-26",
        "last_updated": "2021-11-28",
        "certification_date": "2021-11-28",
        "status": "A",
        "authorized_official_last_name": "HOGG",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "573-712-2992"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Colonial Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Doniphan, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2021; 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.