Provider Demographics
NPI:1316976491
Name:COLONIAL MANORS OF OAKLAND, IOWA, INC.
Entity type:Organization
Organization Name:COLONIAL MANORS OF OAKLAND, IOWA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:PLEAK
Authorized Official - Suffix:
Authorized Official - Credentials:CNHA
Authorized Official - Phone:712-482-6403
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:IA
Mailing Address - Zip Code:51560-0459
Mailing Address - Country:US
Mailing Address - Phone:712-482-6403
Mailing Address - Fax:712-482-6879
Practice Address - Street 1:737 NORTH HIWAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:IA
Practice Address - Zip Code:51560-0459
Practice Address - Country:US
Practice Address - Phone:712-482-6403
Practice Address - Fax:712-482-6879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA780147313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0802967Medicaid
IA165230Medicare Oscar/Certification