Provider Demographics
NPI:1003256082
Name:CROSSROADS ADDICTION & MENTAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:CROSSROADS ADDICTION & MENTAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:712-301-4518
Mailing Address - Street 1:1000 W 29TH ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-3852
Mailing Address - Country:US
Mailing Address - Phone:712-574-4357
Mailing Address - Fax:
Practice Address - Street 1:1000 W 29TH ST
Practice Address - Street 2:SUITE 320
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3852
Practice Address - Country:US
Practice Address - Phone:712-574-4357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-05
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE569251S00000X
NE901251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026366800Medicaid