Organization
BURR OAK MANOR, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA S PREDICK (OWNER/EXECUTIVE DIRECTOR)
(262) 279-9990
Entity
Organization
Contact information
Practice address
264 WALWORTH ST, GENOA CITY, WI 53128-2147
(262) 279-9990
(262) 279-9622
Mailing address
PO BOX 304, DELAVAN, WI 53115-0304
(262) 279-9990
(262) 279-9922
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
310321
WI
3104A0625X
Assisted Living Facility (Mental Illness)
310321
WI
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
310321
WI
311500000X
Alzheimer Center (Dementia Center)
310321
WI
313M00000X
Nursing Facility/Intermediate Care Facility
310321
WI
315D00000X
Inpatient Hospice
310321
WI
Other
Enumeration date
11/07/2014
Last updated
11/07/2014
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