Provider Demographics
NPI:1689950636
Name:CROSSROADS TREATMENT CENTER OF COLUMBIA
Entity Type:Organization
Organization Name:CROSSROADS TREATMENT CENTER OF COLUMBIA
Other - Org Name:CROSSROADS TREATMENT CENTER OF COLUMBIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-733-5855
Mailing Address - Street 1:200 E BROAD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2891
Mailing Address - Country:US
Mailing Address - Phone:800-805-6989
Mailing Address - Fax:864-558-8511
Practice Address - Street 1:1421 BLUFF RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-4809
Practice Address - Country:US
Practice Address - Phone:803-733-5855
Practice Address - Fax:803-733-5892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-21
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC132383336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4230431OtherNCPDP PROVIDER IDENTIFICATION NUMBER