Provider Demographics
NPI:1124201462
Name:CROSS COUNTER, INC
Entity Type:Organization
Organization Name:CROSS COUNTER, INC
Other - Org Name:ST. TIMOTHY'S GROUP HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-621-2273
Mailing Address - Street 1:25 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2001
Mailing Address - Country:US
Mailing Address - Phone:973-621-2273
Mailing Address - Fax:973-621-0047
Practice Address - Street 1:399 HEYWOOD AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-2006
Practice Address - Country:US
Practice Address - Phone:973-673-4562
Practice Address - Fax:973-673-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2200251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8488509Medicaid