Provider Demographics
NPI:1164883385
Name:CROSSROADS REHAB LLC
Entity Type:Organization
Organization Name:CROSSROADS REHAB LLC
Other - Org Name:KONA REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-334-0806
Mailing Address - Street 1:75-1029 HENRY ST STE 101
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1666
Mailing Address - Country:US
Mailing Address - Phone:808-334-0806
Mailing Address - Fax:808-334-0483
Practice Address - Street 1:75-1029 HENRY ST STE 101
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1666
Practice Address - Country:US
Practice Address - Phone:808-334-0806
Practice Address - Fax:808-334-0483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty