Provider Demographics
NPI:1225327356
Name:CROSSROADS HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:CROSSROADS HOME CARE SERVICES, LLC
Other - Org Name:REGIONAL HOSPICE MARION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR. BUSSINESS OFFICE SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:1201 WEAVER RD
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-2621
Mailing Address - Country:US
Mailing Address - Phone:618-988-1840
Mailing Address - Fax:618-988-8623
Practice Address - Street 1:1201 WEAVER RD
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-2621
Practice Address - Country:US
Practice Address - Phone:618-988-1840
Practice Address - Fax:618-988-8623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based