Provider Demographics
NPI:1609432731
Name:CROSSROADS CHURCH
Entity Type:Organization
Organization Name:CROSSROADS CHURCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF BOARD
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:B
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-925-2090
Mailing Address - Street 1:3151 N PIPER AVE
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-3725
Mailing Address - Country:US
Mailing Address - Phone:520-560-4077
Mailing Address - Fax:
Practice Address - Street 1:3151 N PIPER AVE
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-3725
Practice Address - Country:US
Practice Address - Phone:520-560-4077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty