Provider Demographics
NPI:1639362957
Name:CROSSROADS SLEEP DISORDERS CENTER LLC
Entity Type:Organization
Organization Name:CROSSROADS SLEEP DISORDERS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-965-0220
Mailing Address - Street 1:721 BOARDMAN-POLAND RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512
Mailing Address - Country:US
Mailing Address - Phone:330-965-0220
Mailing Address - Fax:330-965-9622
Practice Address - Street 1:721 BOARDMAN POLAND RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5107
Practice Address - Country:US
Practice Address - Phone:330-965-0220
Practice Address - Fax:330-965-9622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-084112261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2488151Medicaid
OHCR9345071Medicare PIN
OHP99812Medicare UPIN