Provider Demographics
NPI:1609085976
Name:CROSSROADS COMMUNITY, INC.
Entity Type:Organization
Organization Name:CROSSROADS COMMUNITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:PLASKON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-758-3050
Mailing Address - Street 1:PO BOX 718
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21617-0718
Mailing Address - Country:US
Mailing Address - Phone:410-758-3050
Mailing Address - Fax:410-758-1223
Practice Address - Street 1:120 BANJO LN
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-1002
Practice Address - Country:US
Practice Address - Phone:410-758-3050
Practice Address - Fax:410-758-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD987430500Medicaid