Provider Demographics
NPI:1316403405
Name:CROSSROADS TREATMENT CENTERS OF TENNESSEE, PC
Entity Type:Organization
Organization Name:CROSSROADS TREATMENT CENTERS OF TENNESSEE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CREDENTIALING
Authorized Official - Middle Name:
Authorized Official - Last Name:STAFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-805-6989
Mailing Address - Street 1:55 BEATTIE PL STE 810
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2191
Mailing Address - Country:US
Mailing Address - Phone:800-805-6989
Mailing Address - Fax:
Practice Address - Street 1:2305 N GATEWAY AVE UNIT 4
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-8683
Practice Address - Country:US
Practice Address - Phone:800-805-6989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty