BURR OAK MANOR INC. NPI 1780080473

NPI Information

  • NPI: 1780080473
  • Provider Name: BURR OAK MANOR, INC.
  • Classification: Assisted Living Facility - 310400000X
  • Entity Type: Organization
  • CLIA Number: 52D0987471
  • Address: 264 WALWORTH ST
    GENOA CITY, WI
    ZIP 53128
  • Phone: (262) 279-9990

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NPI Details

BURR OAK MANOR, INC. is an assisted living facility in Genoa City, WI. The provider is 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. BURR OAK MANOR, INC. NPI is 1780080473. The provider is registered as an organization entity type.

The provider's business location address is:

264 WALWORTH ST
GENOA CITY, WI
ZIP 53128-147
Phone: (262) 279-9990
Fax: (262) 279-9622

The provider's authorized official is Pamela S Predick .
The authorized official title is Owner/executive Director and has the following contact phone number (262) 279-9990.

The CLIA number assigned to this NPI record is 52D0987471 - skilled nursing facility/nursing facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/7/2014 and was last updated on 11/7/2014.

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
13104A0625XAssisted Living FacilityAssisted Living, Mental Illness310321WISCONSINNo
23104A0630XAssisted Living FacilityAssisted Living, Behavioral Disturbances310321WISCONSINNo
3311500000XAlzheimer Center (Dementia Center)310321WISCONSINNo
4313M00000XNursing Facility/Intermediate Care Facility310321WISCONSINNo
5315D00000XHospice, Inpatient310321WISCONSINNo
6310400000XAssisted Living Facility310321WISCONSINYes

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: 11/21/2025

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