Provider Demographics
NPI:1124549613
Name:CROSSROADS HOME CARE, LLC
Entity Type:Organization
Organization Name:CROSSROADS HOME CARE, LLC
Other - Org Name:ARNICARE VILLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:M
Authorized Official - Last Name:MONTAZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-382-1568
Mailing Address - Street 1:3255 BEVEN DR
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-6231
Mailing Address - Country:US
Mailing Address - Phone:858-382-1568
Mailing Address - Fax:
Practice Address - Street 1:1044 JESSICA LN
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-4519
Practice Address - Country:US
Practice Address - Phone:858-382-1568
Practice Address - Fax:760-298-2178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-05
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374603202310400000X
310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA374603202OtherCALIFORNIA COMUNITY CARE LICENSING
CA374604496OtherDEPARTMENT OF SOCIAL SERVICES