Provider Demographics
NPI:1477727519
Name:CROSSROADS ASSISTED LIVING CENTER, INC.
Entity Type:Organization
Organization Name:CROSSROADS ASSISTED LIVING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-316-9491
Mailing Address - Street 1:7960 NW 181ST ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2857
Mailing Address - Country:US
Mailing Address - Phone:786-294-0218
Mailing Address - Fax:786-214-0218
Practice Address - Street 1:7960 NW 181ST ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2857
Practice Address - Country:US
Practice Address - Phone:786-294-0218
Practice Address - Fax:786-214-0218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-19
Last Update Date:2008-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11967225310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility