Provider Demographics
NPI:1013186147
Name:CROSSROADS AT BEAVER CREEK
Entity Type:Organization
Organization Name:CROSSROADS AT BEAVER CREEK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-385-2211
Mailing Address - Street 1:13280 ECHO DELL RD
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9724
Mailing Address - Country:US
Mailing Address - Phone:330-385-1616
Mailing Address - Fax:330-385-8877
Practice Address - Street 1:13280 ECHO DELL RD
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9724
Practice Address - Country:US
Practice Address - Phone:330-385-1616
Practice Address - Fax:330-385-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2485R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility