Provider Demographics
NPI:1598892853
Name:CROSSROADS PROGRAMS
Entity Type:Organization
Organization Name:CROSSROADS PROGRAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-880-0210
Mailing Address - Street 1:610 BEVERLY RANCOCAS RD
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-3736
Mailing Address - Country:US
Mailing Address - Phone:609-880-0210
Mailing Address - Fax:609-880-0230
Practice Address - Street 1:950 JACKSONVILLE RD
Practice Address - Street 2:CAM
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-3343
Practice Address - Country:US
Practice Address - Phone:609-386-3342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1061251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8402604Medicaid