NPIMap

Organization Active NPI

Omni Manor, Inc.

  • Assisted Living Facility
  • Warren, OH
National Provider Identifier
1992058663
Registry record updated Dec 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
OMNI MANOR, INC.
Practice address
1 Windsor Place
Warren, OH 44483
Phone
(330) 841-1555
Fax
(330) 841-2244
NPI assigned
Oct 18, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2012

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

Authorized official

Name
Mr. John J Masternick
Title
Owner/President
Phone
(330) 545-1550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X Primary

Addresses

Primary practice location

1 Windsor Place
Warren, OH 44483

Mailing address

101 W Liberty St
Girard, OH 44420-2844
Phone (330) 545-1550

Other identifiers 1

IdentifierTypeStateIssuer
2619ROtherOHDEPARTMENT OF HEALTH

Other names 1

  • CHAMPION ESTATES 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
36D2284009Champion Estates Assisted Living1 Windsor Place, Warren, OH 44483Certificate 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": "1350518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356912000000",
    "number": "1992058663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 W LIBERTY ST",
            "city": "GIRARD",
            "state": "OH",
            "postal_code": "444202844",
            "telephone_number": "330-545-1550",
            "fax_number": "330-545-2444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WINDSOR PLACE",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "44483",
            "telephone_number": "330-841-1555",
            "fax_number": "330-841-2244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMNI MANOR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-18",
        "last_updated": "2012-12-31",
        "status": "A",
        "authorized_official_last_name": "MASTERNICK",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "330-545-1550",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF HEALTH",
            "identifier": "2619R",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHAMPION ESTATES ASSISTED LIVING RESIDENCE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Warren, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2012; 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.