CCC OF WEST GREEN BAY (NPI# 1073099495) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073099495 |
| Entity Type | Organization |
| Organization Name | CCC OF WEST GREEN BAY |
| Other Organization Name | CROSSROADS CARE CENTER OF WEST GREEN BAY |
| Practice Address |
1760 Shawano Ave Green Bay WI 54303-3216 |
| Mailing Address |
8150 Central Park Ave Skokie IL 60076-2974 |
| Practice Telephone | 8479834860 |
| Mailing Telephone | 8479834860 |
| Enumeration Date | 2018-07-18 |
| Last Update Date | 2018-07-18 |
| Authorized Official Name | DAVID MERZEL (CFO) |
| Authorized Official Telephone | 8479834860 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 000000000 | 05 |
| Other Name | Type Code |
|---|---|
| Crossroads Care Center of West Green Bay | Doing Business As Name - Organization |
| Street Address |
1760 SHAWANO AVE |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54303-3216 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255329983 | Sara E Adams | Physical Therapist | 1760 Shawano Ave, Green Bay, WI 54303-3216 | 2005-10-06 |
| 1164043394 | Bryce Heinzen | Occupational Therapist | 1760 Shawano Ave, Green Bay, WI 54303-3216 | 2020-04-28 |
| 1982259123 | Marisa Albers | Occupational Therapy Assistant | 1760 Shawano Ave, Green Bay, WI 54303-3216 | 2019-08-05 |
| 1831742386 | Samantha Wood | Occupational Therapy Assistant | 1760 Shawano Ave, Green Bay, WI 54303-3216 | 2019-07-23 |
| 1508420654 | Molly Katherine Vizelka | Physical Therapy Assistant | 1760 Shawano Ave, Green Bay, WI 54303-3216 | 2019-04-24 |
| 1730648254 | Victoria Ann Williams | Physical Therapy Assistant | 1760 Shawano Ave, Green Bay, WI 54303-3216 | 2019-03-14 |
| 1023431301 | Jill Ball | Physical Medicine & Rehabilitation | 1760 Shawano Ave, Green Bay, WI 54303-3216 | 2014-01-22 |
| 1225315096 | Nicole Abdo | Physical Therapist | 1760 Shawano Ave, Green Bay, WI 54303-3216 | 2011-11-08 |
| 1386946135 | Susan Laverne Renard | Occupational Therapy Assistant | 1760 Shawano Ave, Green Bay, WI 54303-3216 | 2010-11-30 |
| 1134430721 | Courtney Fitzgerald Martin | Occupational Therapist | 1760 Shawano Ave, Green Bay, WI 54303-3216 | 2010-06-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952921033 | Ashley Marie Vandermoss | Social Worker | 1601 W Mason Street, Green Bay, WI 54303 | 2020-04-20 |
| 1598307423 | Jean Marie Castaneda | Case Manager/Care Coordinator | 2517 N. Court, Green Bay, WI 54303 | 2019-10-11 |
| 1215579552 | Integrated Treatment Centers, LLC | Clinic/Center | 2311 W Mason Street, Green Bay, WI 54303 | 2019-10-08 |
| 1003460551 | Affordable Dentures & Implants - Green Bay, S.c. | Dentist | 1800-c W. Mason Street, Green Bay, WI 54303 | 2019-08-01 |
| 1164940375 | Kaeley Rae Blaney | Student in an Organized Health Care Education/Training Program | 2088 Memorial Drive #208, Green Bay, WI 54303 | 2017-09-07 |
| 1518498047 | Treatment Providers LLC | Clinic/Center | 2731 N Packerland Dr Ste A, Green Bay, WI 54303 | 2017-03-26 |
| 1851840565 | Back To Balance Chiropractic, LLC | Chiropractor | 110 Packerland Drive, Suite B, Green Bay, WI 54303 | 2016-09-23 |
| 1710361001 | Matthew Lemay | Acupuncturist | 727 E Walnut, Suite B2, Green Bay, WI 54303 | 2015-07-16 |
| 1144600149 | Carrie Jean Banaszak | Counselor | 1039 Mason Street, Green Bay, WI 54303 | 2015-06-04 |
| 1174921993 | Kensey Meyer | Occupational Therapy Assistant | 1555 Dousman Road, Seymour, WI 54303 | 2014-12-10 |
| Find all providers in zip 54303 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659736478 | Crystal Fountains Rehabilitation Center LLC | Skilled Nursing Facility | 403 South Clay St, Green Bay, WI 54301-3807 | 2015-12-21 |
| 1588839492 | San Luis Medical & Rehab Center | Skilled Nursing Facility | 2305 San Luis Pl, Green Bay, WI 54304-5211 | 2008-04-23 |
| 1366489171 | Parkview Manor Healthcare LLC | Skilled Nursing Facility | 2961 Saint Anthony Dr, Green Bay, WI 54311-5860 | 2006-06-01 |
| 1225085640 | Beverly Enterprises - Wisconsin, Inc | Skilled Nursing Facility | 1640 Shawano Ave, Green Bay, WI 54303-3214 | 2006-05-30 |
| 1366498388 | Manor Care of Green Bay Wi (east) LLC | Skilled Nursing Facility | 600 S Webster Ave, Green Bay, WI 54301-3503 | 2006-05-25 |
| 1124006739 | Odd Fellow Rebekah Home Association Inc | Skilled Nursing Facility | 1207 S Jackson St, Green Bay, WI 54301-3037 | 2006-01-04 |
| 1578559456 | Santa Maria Nursing Home, Inc. | Skilled Nursing Facility | 430 S Clay St, Green Bay, WI 54301-3807 | 2005-09-26 |
| 1851385231 | Bornemann Nursing Home Inc | Skilled Nursing Facility | 226 Bornemann St, Green Bay, WI 54302 | 2005-08-31 |
| 1689671109 | Zunker Health Care Inc | Skilled Nursing Facility | 1555 Dousman St, Green Bay, WI 54303-3207 | 2005-06-30 |
| 1104394758 | Parkview Nursing and Rehab, LLC | Skilled Nursing Facility | 2961 Saint Anthony Dr, Green Bay, WI 54311-5860 | 2018-11-12 |
| Find all providers in GREEN BAY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.