Provider Demographics
NPI:1831648450
Name:OMNI MANOR, INC.
Entity Type:Organization
Organization Name:OMNI MANOR, INC.
Other - Org Name:ARMSTRONG MEMORY CARE ASSISTED LIVING RESIDENCE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MASTERNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-545-1550
Mailing Address - Street 1:2 WINDSOR PL
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-1456
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 WINDSOR PL
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-1456
Practice Address - Country:US
Practice Address - Phone:330-545-1550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility