Provider Demographics
NPI:1417025461
Name:CROSSROADS TREATMENT CENTER INC
Entity Type:Organization
Organization Name:CROSSROADS TREATMENT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:T
Authorized Official - Last Name:SAUCIER
Authorized Official - Suffix:
Authorized Official - Credentials:SUDP
Authorized Official - Phone:253-473-7474
Mailing Address - Street 1:8717 S HOSMER ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444
Mailing Address - Country:US
Mailing Address - Phone:253-473-7474
Mailing Address - Fax:253-474-9724
Practice Address - Street 1:8717 S HOSMER ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444
Practice Address - Country:US
Practice Address - Phone:253-473-7474
Practice Address - Fax:253-474-9724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA27008500101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA019019001OtherGROUP HEALTH
WACR1264OtherREGENCE BLUESHIELD
WA209641500Medicaid