CRYSTAL FOUNTAINS REHABILITATION CENTER LLC — NPI 1093170813 (Licensed Skilled Nursing & Inpatient Post-Acute Rehabilitation Facility (SNF) in DE PERE, WI)

CMS-1500 Box 24J / 33a • NPI

1093170813

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

314000000X (CMS A1[8])

Licensed Skilled Nursing & Inpatient Post-Acute Rehabilitation Facility (SNF)

Box 32 Service Location & ZIP+4

3737 DICKINSON RD, DE PERE, WI, 54115-8797

✓ 9-Digit EDI 837 ZIP+4 (54115-8797)

Practice Phone & Referral Fax

(920) 336-7733

Fax: (920) 336-3697

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1093170813 (CRYSTAL FOUNTAINS REHABILITATION CENTER LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1093170813` (NPI-2 Organization / Facility)
Provider / Legal Name	CRYSTAL FOUNTAINS REHABILITATION CENTER LLC
Plain-English Specialty	Licensed Skilled Nursing & Inpatient Post-Acute Rehabilitation Facility (SNF) NUCC Code: `314000000X` (Skilled Nursing Facility)
Certifying / Licensing Body	CMS Five-Star Quality Rating System / State Department of Health
Practice Location Address	3737 DICKINSON RD, DE PERE, WI, 54115-8797
Practice Telephone / Fax	Tel: (920) 336-7733 \| Fax: (920) 336-3697
Administrative Mailing Address	3450 BRIDLEWOOD DR, PLOVER, WI, 54467-3892
Enumeration & Last Sync	Enumerated: 2015-12-21 \| CMS Record Updated: 2015-12-21
Authorized Official	KAREN TRZEBIATOWSKI (Director of Operations)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

3737 DICKINSON RD, DE PERE, WI, 54115-8797

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Plain-English Taxonomy & CMS Crosswalk (314000000X)

What Does Taxonomy Code 314000000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 314000000X translates to:
"Licensed Skilled Nursing & Inpatient Post-Acute Rehabilitation Facility (SNF)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code A1[8] (Skilled Nursing Facility)
Certifying / Accrediting Authority: CMS Five-Star Quality Rating System / State Department of Health
Clinical Scope: Inpatient rehabilitation and 24-hour skilled nursing care following major surgery, stroke, or prolonged hospitalization.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (CRYSTAL FOUNTAINS REHABILITATION CENTER LLC)

Typical CPT / Diagnostic Procedures:

24-Hour Skilled Nursing Supervision, Enteral Nutrition & Pressure Ulcer Prevention
Post-Acute Orthopedic, Cardiac & Neurological Inpatient Rehabilitation

Common Therapeutic Classes:

Chronic Disease Maintenance Regimens, Analgesics & Thromboprophylaxis

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`314000000X` — Skilled Nursing Facility Plain English: Licensed Skilled Nursing & Inpatient Post-Acute Rehabilitation Facility (SNF)	State: WI \| License: `3105` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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CRYSTAL FOUNTAINS REHABILITATION CENTER LLC (NPI #1093170813)