Provider Demographics
NPI:1659834075
Name:CROSSROADS SAINT LLC
Entity Type:Organization
Organization Name:CROSSROADS SAINT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MORSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-382-7746
Mailing Address - Street 1:1120 SHADOW LN STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2342
Mailing Address - Country:US
Mailing Address - Phone:702-382-7746
Mailing Address - Fax:702-508-0757
Practice Address - Street 1:1120 SHADOW LN STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2342
Practice Address - Country:US
Practice Address - Phone:702-382-7746
Practice Address - Fax:702-508-0757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty