Provider Demographics
NPI:1609871391
Name:CROSS ROAD HEALTH MINISTRIES, INC.
Entity Type:Organization
Organization Name:CROSS ROAD HEALTH MINISTRIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-822-5686
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:GLENNALLEN
Mailing Address - State:AK
Mailing Address - Zip Code:99588-0589
Mailing Address - Country:US
Mailing Address - Phone:907-822-5686
Mailing Address - Fax:907-822-5684
Practice Address - Street 1:MILE 187 GLENN HIGHWAY
Practice Address - Street 2:
Practice Address - City:GLENNALLEN
Practice Address - State:AK
Practice Address - Zip Code:99588-0589
Practice Address - Country:US
Practice Address - Phone:907-822-3203
Practice Address - Fax:907-822-5805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10300261QF0400X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1083887749OtherLANFEAR NPI
AKDD0262OtherMEDICARE RAILROAD PIN
AK158880436OtherHUGHES NPI
AK1609871391OtherCLINIC NPI
AKRH047FQMedicaid
AK1033282728OtherMEL NPI
AK1093999526OtherCROWE NPI
AK1326021486OtherMELTON NPI
AK1417235904OtherPEPE NPI
AK1467534537OtherPHARM NPI
AK1609990670OtherDEDE NPI
AK1083887749OtherLANFEAR NPI
AK021820Medicare Oscar/Certification