Provider Demographics
NPI:1275930406
Name:CROSSROADS HOME HEALTH, INC.
Entity Type:Organization
Organization Name:CROSSROADS HOME HEALTH, INC.
Other - Org Name:VISITING ANGELS OF ROCKFORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HARLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-977-3452
Mailing Address - Street 1:3600 E STATE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-1978
Mailing Address - Country:US
Mailing Address - Phone:815-977-3452
Mailing Address - Fax:815-977-8162
Practice Address - Street 1:3600 E STATE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-1978
Practice Address - Country:US
Practice Address - Phone:815-977-3452
Practice Address - Fax:815-977-8162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3000983253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3000983OtherILLINOIS DEPARTMENT OF PUBLIC HEALTH LICENSE