Active NPI
Canton Christian Home, Inc
- Skilled Nursing Facility
- Canton, OH
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 1618N
- Legal business name
- CANTON CHRISTIAN HOME, INC
- Practice address
- 2550 Cleveland Ave NW
Canton, OH 44709-3306 - Phone
- (330) 456-0004
- Fax
- (330) 452-9951
- NPI assigned
- Aug 4, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Thomas Strobl
- Title
- Administrator
- Phone
- (330) 456-0004
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 1618N | OH | Primary |
Addresses
Primary practice location
2550 Cleveland Ave NW
Canton, OH 44709-3306
Mailing address
2550 Cleveland Ave NW
Canton, OH 44709-3306
Phone (330) 456-0004
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0345237 | Medicaid | OH | |
| 1618N | Other | OH | STATE LICENSE NUMBER |
| 1618R | Other | OH | RESCARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040805000550 | OH | Part A Provider - Skilled Nursing Facility | 5597736132 | Practice locations: Canton, OH |
Skilled nursing facility certification: CCN 366300
- Legal name
- CANTON CHRISTIAN HOME INC
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Sep 1, 2004
- Last certification
- Mar 23, 2023
- Beds
- 57
- Ownership / control type
- Nonprofit Corporation
- Organization structure
- Corporation
- Incorporated
- May 29, 1969 in OH
- Enrollment address
- 2550 Cleveland Ave NW
Canton, OH 44709-3306 - Nursing home name
- CANTON CHRISTIAN HOME
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Canton Christian Home
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Sep 1, 2004
- Medicare certification status
- Active
- Certified beds
- 57
- Penalties (3 years)
- 1
National Provider Directory
National Provider Directory- Tax ID family
- Canton Christian Home
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Nursing Facility/Intermediate Care Facility
- Canton, OH
- NPI 1376628230
Ownership & related parties
All disclosed owners & managing parties 4
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Robert Nickoson | Corporate Officer | May 20, 2015 | |
| Managing Control - Governing Body | May 20, 2015 | ||
| Trustee of the SNF | May 20, 2015 | ||
| Adp of the SNF | May 20, 2015 | ||
| Heather Yoder | Corporate Director | Feb 6, 2018 | 50% |
| Adp of the SNF | Feb 6, 2018 | ||
| Janine S Stackhouse | Corporate Director | Sep 28, 2023 | 100% |
| Operational/Managerial Control | Sep 28, 2023 | ||
| Adp of the SNF | Sep 28, 2023 | ||
| James Franz | Operational/Managerial Control | Feb 6, 2018 | |
| Adp of the SNF | Feb 6, 2018 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Family Medicine Physician
- Canton, OH
- NPI 1467896100
Adp of the SNF, Operational/Managerial Control
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Canton, OH
- NPI 1467896100
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123113600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1435708800000",
"number": "1982605507",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2550 CLEVELAND AVE NW",
"city": "CANTON",
"state": "OH",
"postal_code": "447093306",
"telephone_number": "330-456-0004",
"fax_number": "330-452-9951"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2550 CLEVELAND AVE NW",
"city": "CANTON",
"state": "OH",
"postal_code": "447093306",
"telephone_number": "330-456-0004",
"fax_number": "330-452-9951"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CANTON CHRISTIAN HOME, INC",
"organizational_subpart": "NO",
"enumeration_date": "2005-08-04",
"last_updated": "2015-07-01",
"status": "A",
"authorized_official_last_name": "STROBL",
"authorized_official_first_name": "THOMAS",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "330-456-0004",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "OH",
"license": "1618N",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0345237",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "1618N",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RESCARE",
"identifier": "1618R",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Canton, OH
- Canton Care, LLC
- Canton Child Neurology LLC
- Canton Chiropractic Acupuncture Clinic
- Canton Chiropractic Center
- Canton Christian Home
- Canton City School District
- Canton College Preparatory School
- Canton Community Kidsummit Against Drugs
- Canton Endovascular & Cardiothoracic Surgery, LLC
- Canton Family Dentistry
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- 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.