Healthcare Provider Details

I. General information

NPI: 1851385231
Provider Name (Legal Business Name): BORNEMANN NURSING HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 BORNEMANN ST
GREEN BAY WI
54302
US

IV. Provider business mailing address

226 BORNEMANN ST
GREEN BAY WI
54302
US

V. Phone/Fax

Practice location:
  • Phone: 920-468-8675
  • Fax: 920-468-0667
Mailing address:
  • Phone: 920-468-8675
  • Fax: 920-468-0667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. BONNIE J DAVIS
Title or Position: NHA OWNER
Credential:
Phone: 920-468-8675