Provider Demographics
NPI:1265496590
Name:THE CROSSROADS CENTER
Entity Type:Organization
Organization Name:THE CROSSROADS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:P
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LISW
Authorized Official - Phone:513-475-5300
Mailing Address - Street 1:311 MARTIN LUTHER KING DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-2484
Mailing Address - Country:US
Mailing Address - Phone:513-475-5300
Mailing Address - Fax:513-281-1645
Practice Address - Street 1:311 MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2484
Practice Address - Country:US
Practice Address - Phone:513-475-5300
Practice Address - Fax:513-475-5394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0315261QM0801X, 261QM0850X, 261QM0855X, 320800000X
OH01258261QR0405X
OH2344324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01258OtherODADAS
OH93.778Medicaid
OH0315OtherODMH
OH31659OtherOHIO DEPT. OF MENTAL HEAL
OH01258OtherODADAS