52D0987471 CLIA NUMBER - BURR OAK MANOR INC

Laboratory Demographics

  • CLIA Code: 52D0987471
  • Facility Name: BURR OAK MANOR INC
  • Facility Address: 264 WALWORTH ST
    GENOA CITY, WI
    ZIP 53128
  • Facility Phone: 262 279-9991
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: MS. PAMELA S. PREDICK
  • NPI Number: 1780080473
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 52D0987471
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name BURR OAK MANOR INC
Street 264 WALWORTH ST
City GENOA CITY
State WI
ZIP 53128
Phone 262 279-9991
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/5/2025
Certificate Expiration Date 6/4/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director MS. PAMELA S. PREDICK

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This page was last updated on: 9/29/2025