Provider Demographics
NPI:1851385231
Name:BORNEMANN NURSING HOME INC
Entity Type:Organization
Organization Name:BORNEMANN NURSING HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NHA OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-468-8675
Mailing Address - Street 1:226 BORNEMANN ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302
Mailing Address - Country:US
Mailing Address - Phone:920-468-8675
Mailing Address - Fax:920-468-0667
Practice Address - Street 1:226 BORNEMANN ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302
Practice Address - Country:US
Practice Address - Phone:920-468-8675
Practice Address - Fax:920-468-0667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20163500Medicaid
WI20163500Medicaid