COLONIAL MANOR LTC, LLC (NPI# 1164411187) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164411187 |
| Entity Type | Organization |
| Organization Name | COLONIAL MANOR LTC, LLC |
| Other Organization Name | COLONIAL NURSING CENTER |
| Practice Address |
1528 Market Ave N Canton OH 44714-2695 |
| Practice Telephone | 3304538466 |
| Practice Fax Number | 3304531424 |
| Mailing Telephone | 3304538466 |
| Mailing Fax Number | 3304531424 |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MICHAEL P SLYK (PRESIDENT) |
| Authorized Official Telephone | 3304243721 |
| Authorized Official Credential | PHARMD FASCP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 313M00000X | Nursing Facility/Intermediate Care Facility | 3620 | OH | Nursing & Custodial Care Facilities |
| X | 314000000X | Skilled Nursing Facility | 3620 | OH | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 0177544 | 05 | |
| OH | 2635938 | 05 |
| Other Name | Type Code |
|---|---|
| Colonial Nursing Center | Doing Business As Name - Organization |
| Street Address |
1528 MARKET AVE N |
| City | CANTON |
| State | OH |
| Zip Code | 44714-2695 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164941365 | Desiree Morgan | Occupational Therapy Assistant | 1634 20th St. N.e., Canton, OH 44714 | 2017-09-19 |
| 1932525706 | Cody Henninge | In Home Supportive Care | 2800 Market Ave N Suite 16, Canton, OH 44714 | 2014-03-17 |
| 1346584984 | Quest Recovery and Prevention Services | Substance Abuse Rehabilitation Facility | 1711 Spring Avenue Nw, Canton, OH 44714 | 2012-11-20 |
| 1780159921 | Lynne Marie Shayko | Counselor | 1341 Market Ave N, Canton, OH 44714 | 2018-10-03 |
| 1427437540 | Robert D Cox | Counselor | 1341 Market Ave N, Canton, OH 44714 | 2015-05-21 |
| 1316336878 | Erika D Putnam | Counselor | 1711 Spring Ave Ne, Canton, OH 44714 | 2015-01-21 |
| 1225435969 | Emily A Custer | Counselor | 1341 Market Ave N, Canton, OH 44714 | 2014-11-24 |
| 1700438363 | Ryan Gernert | Specialist/Technologist | 5323 Gardendale Ave Ne, Canton, OH 44714-1042 | 2019-07-14 |
| 1982171468 | Adrienne Chavers | Home Health | 5438 Market Ave N, Canton, OH 44714-1059 | 2018-11-01 |
| 1912061797 | Living 4 Independence | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4629 Helmsworth Dr Ne, Canton, OH 44714-1162 | 2006-12-19 |
| Find all providers in zip 44714 | ||||
| Taxonomy Code | 313M00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Nursing Facility/Intermediate Care Facility |
| 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. |
| Notes: Source: Paraphrased from Section 1919 (a) of the Social Security Act. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407363849 | Provider Services LLC | Nursing Facility/Intermediate Care Facility | 3071 Dunbarton Ave Nw, Canton, OH 44708-1818 | 2018-01-08 |
| 1720304538 | Astoria Snf, Inc. | Nursing Facility/Intermediate Care Facility | 3537 12th St Nw, Canton, OH 44708-3818 | 2010-04-19 |
| 1780753582 | Smith Nursing Home, Inc | Nursing Facility/Intermediate Care Facility | 2330 Penn Pl Ne, Canton, OH 44704-2266 | 2006-11-07 |
| 1023118114 | Bethany Nursing Home, Inc. | Nursing Facility/Intermediate Care Facility | 626 34th St Nw, Canton, OH 44709-2943 | 2006-09-25 |
| 1083995807 | Bethany Medical Center Inc | Nursing Facility/Intermediate Care Facility | 626 34th St Nw, Canton, OH 44709-2943 | 2011-09-07 |
| 1689825820 | Petersen Health Care | Nursing Facility/Intermediate Care Facility | 129 S 1st Ave, Canton, IL 61520-2612 | 2008-10-07 |
| 1699978460 | Rehabilitation Masters, P.C. | Nursing Facility/Intermediate Care Facility | 45309 Seabrook Dr, Canton, MI 48188-3252 | 2007-06-07 |
| 1376628230 | Canton Christian Home | Nursing Facility/Intermediate Care Facility | 2550 Cleveland Ave Nw, Canton, OH 44709-3306 | 2006-10-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730663139 | Pamela Sue Williams | Nursing Facility/Intermediate Care Facility | 1112 Wamajo Dr, Sandusky, OH 44870-4368 | 2018-09-20 |
| 1518493683 | Melody Sue King | Nursing Facility/Intermediate Care Facility | 822 Youngs Lane, Cincinnati, OH 45245 | 2017-05-10 |
| 1700323631 | Mika Derifield | Nursing Facility/Intermediate Care Facility | 205 S Pardee St, Wadsworth, OH 44281-1465 | 2017-01-30 |
| 1336693860 | Taria Thompson | Nursing Facility/Intermediate Care Facility | 613 E 102nd St, Cleveland, OH 44108-1326 | 2016-08-13 |
| 1205389319 | Soamazin Automotive | Nursing Facility/Intermediate Care Facility | 14115 Maplerow Ave, Cleveland, OH 44105-6447 | 2016-07-26 |
| 1194198143 | Christina Laury | Nursing Facility/Intermediate Care Facility | 7666 Clovernook Ave, Cincinnati, OH 45231-3506 | 2015-11-12 |
| 1437539483 | Arlington Pointe Investment Group, LLC | Nursing Facility/Intermediate Care Facility | 4900 Hendrickson Road, Middletown, OH 45044 | 2015-06-04 |
| 1972981322 | Toward Independence Inc. | Nursing Facility/Intermediate Care Facility | 1841 Pueblo Dr, Xenia, OH 45385-4228 | 2015-05-18 |
| 1053799783 | Toward Independence Inc. | Nursing Facility/Intermediate Care Facility | 5021 Oaklawn Dr, Cincinnati, OH 45227-1433 | 2015-05-14 |
| 1467830190 | Toward Independence Inc. | Nursing Facility/Intermediate Care Facility | 2143 Maryland Dr, Xenia, OH 45385-4629 | 2015-05-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.