CCC of East Green Bay

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CCC OF EAST GREEN BAY

Doing business as

Crossroads Care Center of East Green Bay

Practice address

600 S Webster Ave
Green Bay, WI 54301-3503

Phone

(920) 432-3213

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 L Merzel

Title

Cfo

Phone

(847) 983-4860

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Crossroads Care Center of East Green Bay Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1531872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553817600000",
    "number": "1902382328",
    "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": "600 S WEBSTER AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013503",
            "telephone_number": "920-432-3213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCC OF EAST GREEN BAY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-18",
        "last_updated": "2019-03-29",
        "status": "A",
        "authorized_official_last_name": "MERZEL",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "L",
        "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": "000000",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dmerzel@aahcmgt.com",
            "affiliation": "N",
            "address_1": "600 S Webster Ave",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543013503",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Crossroads Care Center of East Green Bay",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• 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 Mar 29, 2019; 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.