Colonial Long Term Care Facility, Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

HAL-086-002 Issued in NC

Legal business name

COLONIAL LONG TERM CARE FACILITY, INC

Practice address

340 Snowhill Dr
Mount Airy, NC 27030-4394

Phone

(336) 786-2194

Fax

(336) 786-8891

NPI assigned

Jan 18, 2007

Organization subpart

No

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

Authorized official

Name

Mark A. Payne

Title

Administrator

Phone

(336) 786-2194

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Colonial Care, Inc Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282262400000",
    "number": "1942353677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 SNOWHILL DR",
            "city": "MOUNT AIRY",
            "state": "NC",
            "postal_code": "270304394",
            "telephone_number": "336-786-2194",
            "fax_number": "336-786-8891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 SNOWHILL DR",
            "city": "MOUNT AIRY",
            "state": "NC",
            "postal_code": "270304394",
            "telephone_number": "336-786-2194",
            "fax_number": "336-786-8891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLONIAL LONG TERM CARE FACILITY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2010-08-20",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "336-786-2194"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL-086-002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7801494",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colonial Care, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Micaela Christian
• CJM Medical Group, PLLC
• Michael Clark, OD
• Caitlin Suzanna Knox Cline
• David S Collard, DPM
• Casey Combs, LMFT
• Elizabeth Combs, PA
• Michelle Williams Combs, PA-C
• Cindy Fowler Comer, PA-C
• Jenna Marie Comer, DC

• Assisted Living Facility in Mount Airy, NC
• Providers in Mount Airy, NC by specialty
• Assisted Living Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.