Provider Demographics
NPI:1629345640
Name:CROSSROADS ASSOCIATES
Entity Type:Organization
Organization Name:CROSSROADS ASSOCIATES
Other - Org Name:CROSSROADS RESIDENTIAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-226-2834
Mailing Address - Street 1:PO BOX 23126
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95153-3126
Mailing Address - Country:US
Mailing Address - Phone:408-226-2834
Mailing Address - Fax:
Practice Address - Street 1:5487 JUDITH ST
Practice Address - Street 2:#1
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1807
Practice Address - Country:US
Practice Address - Phone:408-226-2834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health