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BURR OAK MANOR, INC.
NPI 1780080473
Assisted Living Facility in Genoa City, WI

Active since November 07, 2014CLIA 52D0987471 · Waiver
264 WALWORTH ST, GENOA CITY, WI 53128(262) 279-9990(262) 279-9622 Get Directions Write a Review

NPPES record last updated: November 7, 2014. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Burr Oak Manor, Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BURR OAK MANOR, INC. (NPI 1780080473) is a healthcare organization registered as an assisted living facility in Genoa City, Wisconsin and active in the NPI registry since November 2014. The organization holds a CLIA Waiver certificate valid through June 4, 2027 and lists Pamela S Predick, Owner/executive Director, as its authorized official.

NPPES Registry Identity

NPI1780080473
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameBURR OAK MANOR, INC.
Location Address264 WALWORTH STGenoa City, WI 53128-2147
Mailing AddressPo Box 304Delavan, WI 53115-0304 · (262) 279-9990 · Fax (262) 279-9922
Phone(262) 279-9990
Fax(262) 279-9622
Organization SubpartNo
Authorized OfficialPamela S PredickOwner/executive Director · (262) 279-9990
Enumeration DateNovember 7, 2014
✔ NPI 1780080473 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 6

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in WI · 310321
Definition

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.

Also ListedAssisted Living Facility · Assisted Living, Mental IllnessTaxonomy 3104A0625X · License 310321 (WI)
Also ListedAssisted Living Facility · Assisted Living, Behavioral DisturbancesTaxonomy 3104A0630X · License 310321 (WI)
Also ListedAlzheimer Center (Dementia Center)Taxonomy 311500000X · License 310321 (WI)
Also ListedNursing Facility/Intermediate Care FacilityTaxonomy 313M00000X · License 310321 (WI)
Also ListedHospice, InpatientTaxonomy 315D00000X · License 310321 (WI)
264 WALWORTH ST, Genoa City, WI 53128
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 52D0987471

Burr Oak Manor Inc · Genoa City, WI
Active · expires Jun 4, 2027
CLIA Number52D0987471
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateJune 5, 2025
Certificate Expiration DateJune 4, 2027
Laboratory DirectorMs. Pamela S. Predick
Laboratory Phone(262) 279-9991
Laboratory LocationBurr Oak Manor Inc264 Walworth St, Genoa City, WI 53128
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Burr Oak Manor, Inc.'s NPI number?

The NPI number for Burr Oak Manor, Inc. is 1780080473. It was assigned to this organization in the NPPES registry on November 7, 2014.

Where is Burr Oak Manor, Inc. located?

Burr Oak Manor, Inc. is located at 264 Walworth St, Genoa City, WI 53128. The listed phone number is (262) 279-9990.

What is Burr Oak Manor, Inc.'s specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Burr Oak Manor, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 52D0987471) is associated with this NPI, valid through June 4, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Burr Oak Manor, Inc. was last updated on November 7, 2014. NPI Profile syncs with the weekly NPPES data releases published by CMS.