Healthcare Provider Details

I. General information

NPI: 1528078342
Provider Name (Legal Business Name): OMNI MANOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 BELMONT AVE
YOUNGSTOWN OH
44504-1111
US

IV. Provider business mailing address

101 W LIBERTY ST
GIRARD OH
44420-2844
US

V. Phone/Fax

Practice location:
  • Phone: 330-743-1393
  • Fax: 330-744-8913
Mailing address:
  • Phone: 330-545-1550
  • Fax: 330-545-2444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN J MASTERNICK
Title or Position: OWNER
Credential:
Phone: 330-545-1550