Provider Demographics
NPI:1578178851
Name:CROSSINGS ADDICTION SERVICES INC, THE
Entity Type:Organization
Organization Name:CROSSINGS ADDICTION SERVICES INC, THE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-448-4342
Mailing Address - Street 1:307 PARK DR
Mailing Address - Street 2:
Mailing Address - City:WAUCHULA
Mailing Address - State:FL
Mailing Address - Zip Code:33873-2413
Mailing Address - Country:US
Mailing Address - Phone:863-448-4342
Mailing Address - Fax:863-448-4096
Practice Address - Street 1:107 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873-2819
Practice Address - Country:US
Practice Address - Phone:863-448-4342
Practice Address - Fax:863-448-4096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-13
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care