Provider Demographics
NPI:1437138070
Name:CROSSROADS HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:CROSSROADS HOME CARE SERVICES, LLC
Other - Org Name:MEDERI CARETENDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GACHASSIN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:373-233-1307
Mailing Address - Street 1:PO BOX 51266
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-1266
Mailing Address - Country:US
Mailing Address - Phone:337-233-1307
Mailing Address - Fax:337-443-4154
Practice Address - Street 1:4111 NORTH TOWER PLACE
Practice Address - Street 2:SUITE E
Practice Address - City:MT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6566
Practice Address - Country:US
Practice Address - Phone:618-988-1840
Practice Address - Fax:618-988-8623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1008390251E00000X
MO1011103251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL581622971005Medicaid
IL147251Medicare Oscar/Certification
147251Medicare Oscar/Certification