Provider Demographics
NPI:1679715353
Name:CROSSROADS CARE CENTER OF WOODSTOCK, LLC
Entity Type:Organization
Organization Name:CROSSROADS CARE CENTER OF WOODSTOCK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:TOPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-338-1700
Mailing Address - Street 1:5454 FARGO AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:309 MCHENRY AVE
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-2917
Practice Address - Country:US
Practice Address - Phone:815-338-1700
Practice Address - Fax:815-338-1765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
14-5222OtherMEDICARE