Provider Demographics
NPI:1093108565
Name:CROSSROADS CARE CENTER OF CRYSTAL RIVER LLC
Entity Type:Organization
Organization Name:CROSSROADS CARE CENTER OF CRYSTAL RIVER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MERZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-983-4860
Mailing Address - Street 1:1401 CHURCHILL ST
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-2027
Mailing Address - Country:US
Mailing Address - Phone:715-258-8131
Mailing Address - Fax:715-258-0179
Practice Address - Street 1:1401 CHURCHILL ST
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-2027
Practice Address - Country:US
Practice Address - Phone:715-258-8131
Practice Address - Fax:715-258-0179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
525339Medicare Oscar/Certification