Provider Demographics
NPI:1366685364
Name:CROSSROADS TREATMENT CENTERS
Entity Type:Organization
Organization Name:CROSSROADS TREATMENT CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:CSAC, CCS
Authorized Official - Phone:336-272-9990
Mailing Address - Street 1:436 SPRING GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2734
Mailing Address - Country:US
Mailing Address - Phone:336-272-9990
Mailing Address - Fax:336-574-8378
Practice Address - Street 1:436 SPRING GARDEN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2734
Practice Address - Country:US
Practice Address - Phone:336-272-9990
Practice Address - Fax:336-574-8378
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TREATMENT CENTERS HOLDCO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-07
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC-10066-M174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty