Colonial Manor Operating Co., Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1544N Issued in OH

Legal business name

COLONIAL MANOR OPERATING CO., INC.

Practice address

196 Colonial Dr
Youngstown, OH 44505-2139

Phone

(330) 759-8000

Fax

(330) 759-4540

NPI assigned

Jun 14, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Thomas D. Nordquist

Title

President

Phone

(330) 726-6047

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Campus Health care Center Doing business as

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

{
    "created_epoch": "1118707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790780153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "196 COLONIAL DR",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445052139",
            "telephone_number": "330-759-8000",
            "fax_number": "330-759-4540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "196 COLONIAL DR",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445052139",
            "telephone_number": "330-759-8000",
            "fax_number": "330-759-4540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLONIAL MANOR OPERATING CO., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NORDQUIST",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "330-726-6047",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "1544N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSING HOME LICENSE #",
            "identifier": "1544N",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2488080",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Campus Health care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Youngstown, OH
• Providers in Youngstown, OH by specialty
• Skilled Nursing Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.