CCC of East Fond Du Lac

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CCC OF EAST FOND DU LAC

Doing business as

Crossroads Care Center of East Fond du Lac

Practice address

265 S National Ave
Fond Du Lac, WI 54935-5334

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 East Fond du Lac Doing business as

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

{
    "created_epoch": "1531872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531872000000",
    "number": "1972089399",
    "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": "265 S NATIONAL AVE",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549355334",
            "telephone_number": "847-983-4860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCC OF EAST FOND DU LAC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-18",
        "last_updated": "2018-07-18",
        "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": "00000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crossroads Care Center of East Fond du Lac",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christopher Casey
• Catherine M Caspary, NP
• Katie Danielle Castillo
• James E Cauley, MD
• Kristin Lee Cavill, SLP
• Central Point Transit
• Central Transit
• Central Wisconsin Radiation Oncology, S.C.
• Paul R Chambers, MD
• Christy Chang, APNP

• Skilled Nursing Facility in Fond Du Lac, WI
• Providers in Fond Du Lac, 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 Jul 18, 2018; 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.