Provider Demographics
NPI:1346407467
Name:HOUSE OF THE CROSSROADS
Entity Type:Organization
Organization Name:HOUSE OF THE CROSSROADS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DEMARZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-281-5265
Mailing Address - Street 1:2012 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-6302
Mailing Address - Country:US
Mailing Address - Phone:412-281-5080
Mailing Address - Fax:412-281-4397
Practice Address - Street 1:2012 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-6302
Practice Address - Country:US
Practice Address - Phone:412-281-5080
Practice Address - Fax:412-281-4397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA740096324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01816260Medicaid