Provider Demographics
NPI:1225341324
Name:CROSSWORKS INC
Entity Type:Organization
Organization Name:CROSSWORKS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:252-446-6964
Mailing Address - Street 1:PO BOX 6795
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27802-6795
Mailing Address - Country:US
Mailing Address - Phone:252-446-6964
Mailing Address - Fax:252-442-4531
Practice Address - Street 1:1041 NOELL LN
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2058
Practice Address - Country:US
Practice Address - Phone:252-446-6964
Practice Address - Fax:252-442-4531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-17
Last Update Date:2010-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000495133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty