Provider Demographics
NPI:1053451179
Name:THE CROSS ROAD REST AND RETIREMENT CENTER, INC
Entity Type:Organization
Organization Name:THE CROSS ROAD REST AND RETIREMENT CENTER, INC
Other - Org Name:CROSS ROAD RETIREMENT COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RUMBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-629-7811
Mailing Address - Street 1:1302 OLD COX RD
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27205-9466
Mailing Address - Country:US
Mailing Address - Phone:336-629-7811
Mailing Address - Fax:336-629-6264
Practice Address - Street 1:1302 OLD COX RD
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27205-9466
Practice Address - Country:US
Practice Address - Phone:336-629-7811
Practice Address - Fax:336-629-6264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCREGISTRATION310400000X
NCHAL-076-003311500000X, 311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Not Answered311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC76 292 ROtherNC DEPT OF REVENUE NUMBER
NC7801111Medicaid