Crystal Fountains Rehabilitation Center LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1134 Issued in WI

Legal business name

CRYSTAL FOUNTAINS REHABILITATION CENTER LLC

Practice address

403 South Clay St
Green Bay, WI 54301-3807

Phone

(920) 432-5231

Fax

(920) 432-9881

NPI assigned

Dec 21, 2015

Organization subpart

No

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

Authorized official

Name

Karen Trzebiatowski, RN

Title

Director of Operations

Phone

(715) 340-1479

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Santa Maria Nursing Home Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1450656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450656000000",
    "number": "1659736478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 BRIDLEWOOD DR",
            "city": "PLOVER",
            "state": "WI",
            "postal_code": "544673892",
            "telephone_number": "715-342-9100",
            "fax_number": "715-342-9101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 SOUTH CLAY ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013807",
            "telephone_number": "920-432-5231",
            "fax_number": "920-432-9881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL FOUNTAINS REHABILITATION CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-21",
        "last_updated": "2015-12-21",
        "status": "A",
        "authorized_official_last_name": "TRZEBIATOWSKI",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "715-340-1479",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "1134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20152400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Santa Maria Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kristen Ann Crosson, APNP
• Robert James Crowley, D.D.S.
• Shantel Crownover, MS
• Paula S. Crum, D.D.S., M.S.
• Francisco P Cruz, MD
• Miranda Mary Cseter, PA-C
• CT Imaging LLC
• Regina E Cuellar-Proctor, LPC, CSAC
• Wilson Cesar Cueva, M.D.
• Aramar Cuevas Tellez

• 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 Dec 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.