Organization
CCC OF EAST FOND DU LAC
Active
Other names
Crossroads Care Center of East Fond du Lac
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID MERZEL (CFO)
(847) 983-4860
Entity
Organization
Contact information
Practice address
265 S NATIONAL AVE, FOND DU LAC, WI 54935-5334
(847) 983-4860
Mailing address
8150 CENTRAL PARK AVE, SKOKIE, IL 60076-2974
(847) 983-4860
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000
—
WI
Enumeration date
07/18/2018
Last updated
07/18/2018
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