Provider Demographics
NPI:1659839470
Name:CROSS RIVERS, LLC
Entity Type:Organization
Organization Name:CROSS RIVERS, LLC
Other - Org Name:CROSS RIVERS, LLC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHUKWUEMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:IGWE
Authorized Official - Suffix:
Authorized Official - Credentials:LAWYER
Authorized Official - Phone:215-398-5564
Mailing Address - Street 1:1500 JFK BLVD STE 1900
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1714
Mailing Address - Country:US
Mailing Address - Phone:215-398-5564
Mailing Address - Fax:
Practice Address - Street 1:1500 JFK BLVD STE 1900
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1714
Practice Address - Country:US
Practice Address - Phone:215-398-5564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1034698440001Medicaid