Burr Oak Manor, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

310321 Issued in WI

Legal business name

BURR OAK MANOR, INC.

Practice address

264 Walworth St
Genoa City, WI 53128-2147

Phone

(262) 279-9990

Fax

(262) 279-9622

NPI assigned

Nov 7, 2014

Last updated

Nov 7, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Pamela S Predick

Title

Owner/Executive Director

Phone

(262) 279-9990

Specialties & licenses 6

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1415318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415318400000",
    "number": "1780080473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 304",
            "city": "DELAVAN",
            "state": "WI",
            "postal_code": "531150304",
            "telephone_number": "262-279-9990",
            "fax_number": "262-279-9922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "264 WALWORTH ST",
            "city": "GENOA CITY",
            "state": "WI",
            "postal_code": "531282147",
            "telephone_number": "262-279-9990",
            "fax_number": "262-279-9622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BURR OAK MANOR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-07",
        "last_updated": "2014-11-07",
        "status": "A",
        "authorized_official_last_name": "PREDICK",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER/EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "262-279-9990"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "WI",
            "license": "310321",
            "primary": true
        },
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "WI",
            "license": "310321",
            "primary": false
        },
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": "WI",
            "license": "310321",
            "primary": false
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "WI",
            "license": "310321",
            "primary": false
        },
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "WI",
            "license": "310321",
            "primary": false
        },
        {
            "code": "315D00000X",
            "taxonomy_group": "",
            "desc": "Hospice, Inpatient",
            "state": "WI",
            "license": "310321",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas A Batson, PT, DPT
• Aimee Blood, RN
• Brookwood School JT School Dist 2 (Genoa City Jt 2 School District)
• Albert Joseph Dietz Jr., MD
• Sharon Lee Ehrlich, LPN
• Jennifer Ann Frisby
• Lucia G Garrity, R.N.
• Geneva Surgical Suites, LLC

• Assisted Living Facility in Genoa City, WI
• Providers in Genoa City, WI by specialty
• Assisted Living Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.