MEDICARE: BORNEMANN NURSING HOME INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851385231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BORNEMANN NURSING HOME INC

Provider Business Mailing Address
First Line	:	226 BORNEMANN ST
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54302
Country	:	US
Telephone Number	:	920-468-8675
Fax Number	:	920-468-0667

Provider Business Practice Location Address
First Line	:	226 BORNEMANN ST
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54302
Country	:	US
Telephone Number	:	920-468-8675
Fax Number	:	920-468-0667

Authorized Official
Title or Position	:	NHA OWNER
Name	:	MRS. BONNIE J DAVIS
Credential	:
Telephone Number	:	920-468-8675

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	08/22/2020

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