Provider Demographics
NPI:1376107292
Name:CROSSROADS WEST
Entity Type:Organization
Organization Name:CROSSROADS WEST
Other - Org Name:WEST OUTPATIENT
Other - Org Type:Other Name
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-263-5242
Mailing Address - Street 1:2002 E OSBORN RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7236
Mailing Address - Country:US
Mailing Address - Phone:602-263-5242
Mailing Address - Fax:602-595-4434
Practice Address - Street 1:7523 N 35TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-7422
Practice Address - Country:US
Practice Address - Phone:602-263-5242
Practice Address - Fax:602-595-4434
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CROSSROADS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-25
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility