Provider Demographics
NPI:1053463752
Name:CROSSPEAKS SERVICES, INC.
Entity Type:Organization
Organization Name:CROSSPEAKS SERVICES, INC.
Other - Org Name:RIDGELINE PEDIATRIC DAY HEALTH AND RESPITE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:435-881-6338
Mailing Address - Street 1:1121 MAIDU DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-5808
Mailing Address - Country:US
Mailing Address - Phone:530-477-3378
Mailing Address - Fax:530-477-7068
Practice Address - Street 1:11270 ROUGH AND READY HWY
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-8530
Practice Address - Country:US
Practice Address - Phone:530-477-3378
Practice Address - Fax:530-477-7068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5500000173140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA0890OtherALTA CALIFORNIA REGIONAL CENTER
CAEPSP00110OtherMEDI-CAL PROVIDER NUMBER