Provider Demographics
NPI:1992058663
Name:OMNI MANOR, INC.
Entity type:Organization
Organization Name:OMNI MANOR, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:101 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 1:1 WINDSOR PLACE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483
Practice Address - Country:US
Practice Address - Phone:330-841-1555
Practice Address - Fax:330-841-2244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2619ROtherDEPARTMENT OF HEALTH