Provider Demographics
NPI:1407213390
Name:THE WAY, TRUTH & LIGHT - AFTER CARE & MENTORING PROGRAM
Entity Type:Organization
Organization Name:THE WAY, TRUTH & LIGHT - AFTER CARE & MENTORING PROGRAM
Other - Org Name:CROSSROADS HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-854-4309
Mailing Address - Street 1:460 NORTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-2204
Mailing Address - Country:US
Mailing Address - Phone:216-854-4309
Mailing Address - Fax:216-365-3730
Practice Address - Street 1:460 NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2204
Practice Address - Country:US
Practice Address - Phone:216-854-4309
Practice Address - Fax:216-365-3730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty