Provider Demographics
NPI:1376255240
Name:CROSSROADS: SOLUTIONS FOR LIFE LLC
Entity Type:Organization
Organization Name:CROSSROADS: SOLUTIONS FOR LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAIRS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:651-249-1750
Mailing Address - Street 1:PO BOX 270696
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-0696
Mailing Address - Country:US
Mailing Address - Phone:651-249-1750
Mailing Address - Fax:
Practice Address - Street 1:1030 COUNTY ROAD E W STE 220
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8153
Practice Address - Country:US
Practice Address - Phone:651-249-1750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-22
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health