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
02/09/2026
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