CCC of West Green Bay LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CCC OF WEST GREEN BAY LLC

Doing business as

Crossroads Care Center of West Green Bay

Practice address

1760 Shawano Ave
Green Bay, WI 54303-3216

Phone

(847) 983-4860

NPI assigned

Jul 18, 2018

Organization subpart

No

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

Authorized official

Name

David Merzel

Title

Cfo

Phone

(847) 983-4860

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Crossroads Care Center of West Green Bay Doing business as

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": "1531872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722902400000",
    "number": "1073099495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8150 CENTRAL PARK AVE",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600762974",
            "telephone_number": "847-983-4860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1760 SHAWANO AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543033216",
            "telephone_number": "847-983-4860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCC OF WEST GREEN BAY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-18",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A",
        "authorized_official_last_name": "MERZEL",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "847-983-4860"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000000000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crossroads Care Center of West Green Bay",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Catholic Charities of the Diocese of Green Bay Inc
• Geffrey E Cavallin, MD
• Sue Cavallin, MA, CCC-SLP
• Lisa J Cavil, LPC
• CCC of East Green Bay (Crossroads Care Center of East Green Bay)
• Center for Asthma & Allergy, Inc.
• Center for Asthma & Allergy, Inc.
• Center for Childhood Safety
• Centerpiece
• Centerpiece LLC

• Skilled Nursing Facility in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Skilled Nursing Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; 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.