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COLONIAL MANOR LTC LLC NPI 1164411187


NPI Information

NPI: 1164411187
Provider Name: COLONIAL MANOR LTC, LLC

Doing Business As: COLONIAL NURSING CENTER

Classification: Nursing Facility/Intermediate Care Facility - 313M00000X
Entity Type: Organization
Address:
1528 MARKET AVE N
CANTON, OH
ZIP 44714
Phone: (330) 453-8466
Get Directions

COLONIAL MANOR LTC, LLC is a nursing facility intermediate care facility in Canton, OH. The provider is an institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. COLONIAL MANOR LTC, LLC NPI is 1164411187. The provider is registered as an organization entity type.
The provider Is Doing Business As Colonial Nursing Center.

The provider's business location address is:

1528 MARKET AVE N
CANTON, OH
ZIP 44714-695
Phone: (330) 453-8466
Fax: (330) 453-1424

The provider's authorized official is Michael P Slyk .
The authorized official title is President and has the following contact phone number (330) 424-3721.

The enumeration date for this NPI number is 10/21/2005 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1313M00000XNursing Facility/Intermediate Care Facility3620OHIOYes
2314000000XSkilled Nursing Facility3620OHIOX

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10177544MEDICAIDOHIO
22635938MEDICAIDOHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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