Provider Demographics
NPI:1356072318
Name:CROSSROADS RECOVERY CENTER OF LOUISIANA
Entity Type:Organization
Organization Name:CROSSROADS RECOVERY CENTER OF LOUISIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIK
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:225-390-1238
Mailing Address - Street 1:4626 SHERWOOD COMMON BLVD STE 402
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-5029
Mailing Address - Country:US
Mailing Address - Phone:225-239-7088
Mailing Address - Fax:
Practice Address - Street 1:4626 SHERWOOD COMMON BLVD STE 402
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-5029
Practice Address - Country:US
Practice Address - Phone:225-239-7088
Practice Address - Fax:225-239-7089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-21
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty