BURR OAK MANOR, INC. (NPI# 1780080473) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780080473 |
| Entity Type | Organization |
| Organization Name | BURR OAK MANOR, INC. |
| Practice Address |
264 Walworth St Genoa City WI 53128-2147 |
| Mailing Address |
Po Box 304 Delavan WI 53115-0304 |
| Practice Telephone | 2622799990 |
| Practice Fax Number | 2622799622 |
| Mailing Telephone | 2622799990 |
| Mailing Fax Number | 2622799922 |
| Enumeration Date | 2014-11-07 |
| Last Update Date | 2014-11-07 |
| Authorized Official Name | PAMELA S PREDICK (OWNER/EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 2622799990 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3104A0625X |
Assisted Living Facility Specialization: Assisted Living, Mental Illness |
310321 | WI | Nursing & Custodial Care Facilities |
| N | 3104A0630X |
Assisted Living Facility Specialization: Assisted Living, Behavioral Disturbances |
310321 | WI | Nursing & Custodial Care Facilities |
| N | 311500000X | Alzheimer Center (Dementia Center) | 310321 | WI | Nursing & Custodial Care Facilities |
| N | 313M00000X | Nursing Facility/Intermediate Care Facility | 310321 | WI | Nursing & Custodial Care Facilities |
| N | 315D00000X | Hospice, Inpatient | 310321 | WI | Nursing & Custodial Care Facilities |
| Y | 310400000X | Assisted Living Facility | 310321 | WI | Nursing & Custodial Care Facilities |
| Street Address |
264 WALWORTH ST |
| City | GENOA CITY |
| State | WI |
| Zip Code | 53128-2147 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558376970 | Nicholas A Batson | Physical Therapist | 313 Freeman Street, Genoa City, WI 53128 | 2006-07-31 |
| 1164720587 | Genoa City Physical Therapy | Physical Therapist | 313 Freeman Street, Genoa City, WI 53128 | 2011-03-09 |
| 1679772669 | Mary M. Waller | Dentist | 501 Freeman St., Genoa City, WI 53128-0159 | 2007-07-11 |
| 1902204878 | Catherine Lindskog | Counselor | 39610 Lake Park Ct, Genoa City, WI 53128-1283 | 2014-12-09 |
| 1629451786 | Virginia Lantz | Licensed Practical Nurse | W1026 Green Rd, Genoa City, WI 53128-1448 | 2015-07-07 |
| 1508291238 | Therese Marie O'grady | Registered Nurse | W1007 Violet Rd, Genoa City, WI 53128-1666 | 2013-09-12 |
| 1144528415 | Sharon Lee Ehrlich | Licensed Practical Nurse | N913 Rose Drive, Genoa City, WI 53128-1924 | 2011-03-10 |
| 1699066118 | Jaclyn Joy Webster | Registered Nurse | 1007 Mallard Ln, Genoa City, WI 53128-1995 | 2011-05-02 |
| 1952457269 | Cynthia Rae Klabunde | Registered Nurse | 949 Bonnie Ln, Genoa City, WI 53128-2062 | 2007-01-27 |
| 1588132260 | Genoa City Fyzical, LLC | Clinic/Center | 112 Elizabeth Ln Unit C, Genoa City, WI 53128-2120 | 2018-11-11 |
| Find all providers in zip 53128 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326654534 | Praitie Assisted Living Inc. | Assisted Living Facility | 749 E Oshkosh St, Ripon, WI 54971-1258 | 2020-09-22 |
| 1295340016 | St. Elizabeth Manor, Inc. | Assisted Living Facility | 111 Commercial Dr, Footville, WI 53537 | 2020-09-09 |
| 1730793001 | Zinzendorf Hall, Inc. | Assisted Living Facility | 1047 Hill St, Watertown, WI 53098-3015 | 2020-09-03 |
| 1184236044 | Francine Carter | Assisted Living Facility | 4341 N 19th St, Milwaukee, WI 53209-6831 | 2020-08-20 |
| 1598377905 | Nohc Jackson Senior Living LLC | Assisted Living Facility | N16744 Eagle Drive, Jackson, WI 53037 | 2020-08-18 |
| 1003427766 | Nohc Magnolia Meadows LLC | Assisted Living Facility | 1480 N 7th St, Manitowoc, WI 54220-2012 | 2020-08-14 |
| 1922616580 | Rheuvonia Reed | Assisted Living Facility | 543 E Arbor Cir, Oak Creek, WI 53154-8528 | 2020-07-20 |
| 1912515073 | Baldwin Coh, LLC | Assisted Living Facility | 1880 4th Ave, Baldwin, WI 54002-5134 | 2020-07-15 |
| 1427666593 | Hudson Coh II, LLC | Assisted Living Facility | 805 Heggen St, Hudson, WI 54016-5005 | 2020-07-15 |
| 1366050429 | Hudson Coh, LLC | Assisted Living Facility | 1111 Heggen St, Hudson, WI 54016-9222 | 2020-07-15 |
| Find all providers with the same taxonomy | ||||
| City | GENOA CITY |
| Zip Code | 53128 |
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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.