ANTWERP MANOR ASSISTED LIVING, LLC — NPI 1003155367 (Licensed & Credentialed Assisted Living Facility in ANTWERP, OH)

CMS-1500 Box 24J / 33a • NPI

1003155367

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

310400000X

Licensed & Credentialed Assisted Living Facility

Box 32 Service Location & ZIP+4

204 ARCHER DR, ANTWERP, OH, 45813-8499

✓ 9-Digit EDI 837 ZIP+4 (45813-8499)

Practice Phone & Referral Fax

(419) 258-1500

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1003155367 (ANTWERP MANOR ASSISTED LIVING, LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1003155367` (NPI-2 Organization / Facility)
Provider / Legal Name	ANTWERP MANOR ASSISTED LIVING, LLC
Plain-English Specialty	Licensed & Credentialed Assisted Living Facility NUCC Code: `310400000X` (Assisted Living Facility)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	204 ARCHER DR, ANTWERP, OH, 45813-8499
Practice Telephone / Fax	Tel: (419) 258-1500
Administrative Mailing Address	120 W MAIN ST STE 200, VAN WERT, OH, 45891-1761
Enumeration & Last Sync	Enumerated: 2013-02-06 \| CMS Record Updated: 2025-11-19
Authorized Official	BRYAN CASEY (Partner)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

204 ARCHER DR, ANTWERP, OH, 45813-8499

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Plain-English Taxonomy & CMS Crosswalk (310400000X)

What Does Taxonomy Code 310400000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 310400000X translates to:
"Licensed & Credentialed Assisted Living Facility"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Assisted Living Facility for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ANTWERP MANOR ASSISTED LIVING, LLC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`310400000X` — Assisted Living Facility Plain English: Licensed & Credentialed Assisted Living Facility	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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ANTWERP MANOR ASSISTED LIVING, LLC (NPI #1003155367)