Provider Demographics
NPI:1902816739
Name:OMNI MANOR, INC.
Entity Type:Organization
Organization Name:OMNI MANOR, INC.
Other - Org Name:OMNI MANOR HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
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 1:101 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-2844
Mailing Address - Country:US
Mailing Address - Phone:330-545-1550
Mailing Address - Fax:330-545-2444
Practice Address - Street 1:3245 VESTAL RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509-1062
Practice Address - Country:US
Practice Address - Phone:330-793-5648
Practice Address - Fax:330-793-4303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0416722Medicaid
OH365433Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER