Provider Demographics
NPI:1114625969
Name:CROSSROADS CARE SERVICES LLC
Entity Type:Organization
Organization Name:CROSSROADS CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-346-2200
Mailing Address - Street 1:122 MILL ST
Mailing Address - Street 2:
Mailing Address - City:WARTBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37887-4303
Mailing Address - Country:US
Mailing Address - Phone:423-346-2200
Mailing Address - Fax:423-346-5655
Practice Address - Street 1:122 MILL ST
Practice Address - Street 2:
Practice Address - City:WARTBURG
Practice Address - State:TN
Practice Address - Zip Code:37887-4303
Practice Address - Country:US
Practice Address - Phone:423-346-2200
Practice Address - Fax:423-346-5655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care