Provider Demographics
NPI:1366674913
Name:CROSSROADS WELLNESS AND REHAB, PA
Entity Type:Organization
Organization Name:CROSSROADS WELLNESS AND REHAB, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-989-1888
Mailing Address - Street 1:27 ANNETTE DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-8045
Mailing Address - Country:US
Mailing Address - Phone:919-989-1888
Mailing Address - Fax:919-989-1898
Practice Address - Street 1:27 ANNETTE DR
Practice Address - Street 2:SUITE 109
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-8045
Practice Address - Country:US
Practice Address - Phone:919-989-1888
Practice Address - Fax:919-989-1898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400430207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty