Provider Demographics
NPI:1124304092
Name:COLER LONG TERM CARE, LTD
Entity type:Organization
Organization Name:COLER LONG TERM CARE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:740-452-7685
Mailing Address - Street 1:1815 CHANDLERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-4644
Mailing Address - Country:US
Mailing Address - Phone:740-452-7685
Mailing Address - Fax:740-452-7655
Practice Address - Street 1:1811 CHANDLERSVILLE RD
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-4644
Practice Address - Country:US
Practice Address - Phone:740-454-2086
Practice Address - Fax:740-453-3026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022171250333600000X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0060285Medicaid