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Organization
CCC OF PEWAUKEE LLC
Active
Organization
CCC OF PEWAUKEE LLC
Active
Other names
Crossroads Care Center of Pewaukee, Avina of Pewaukee
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID MERZEL (CFO)
(847) 983-4860
Entity
Organization
Contact information
Practice address
N26W23977 WATERTOWN RD, WAUKESHA, WI 53188-1006
(847) 983-4860
Mailing address
5454 FARGO AVE, SKOKIE, IL 60077-3210
(847) 983-4860
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000000
—
WI
05
—
1578049995
—
WI
Enumeration date
07/18/2018
Last updated
06/04/2026
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