NPIMap

Organization Active NPI

Omni Manor, Inc.

  • Assisted Living Facility
  • Youngstown, OH
National Provider Identifier
1275739450
Registry record updated Jun 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
5639 Issued in OH
Legal business name
OMNI MANOR, INC.
Practice address
1353 Churchill Hubbard Rd
Youngstown, OH 44505-1380
Phone
(330) 759-2893
Fax
(330) 759-2920
NPI assigned
Jun 25, 2007
Last updated
Jun 18, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jodi Mitchell, RN
Title
Director
Phone
(330) 759-2893

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 5639 OH Primary

Addresses

Primary practice location

1353 Churchill Hubbard Rd
Youngstown, OH 44505-1380

Mailing address

1353 Churchill Hubbard Rd
Youngstown, OH 44505-1380
Phone (330) 759-2893

Other identifiers 2

IdentifierTypeStateIssuer
5639OtherOHSTATE LICENSE NUMBER
2113ROtherOHSTATE FACILITY NUMBER

Other names 1

  • LIBERTY ARMS ASSISTED LIVING RESIDENCE Other name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D2284045Liberty Arms Assisted Living1353 Churchill-Hubbard Rd, Youngstown, OH 44505Certificate of waiverJun 14, 2027

National Provider Directory

National Provider Directory
Tax ID family
Omni Manor Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1275739450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1353 CHURCHILL HUBBARD RD",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445051380",
            "telephone_number": "330-759-2893",
            "fax_number": "330-759-2920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1353 CHURCHILL HUBBARD RD",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445051380",
            "telephone_number": "330-759-2893",
            "fax_number": "330-759-2920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMNI MANOR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-25",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "JODI",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "330-759-2893",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "OH",
            "license": "5639",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "5639",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE FACILITY NUMBER",
            "identifier": "2113R",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LIBERTY ARMS ASSISTED LIVING RESIDENCE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Youngstown, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.