Provider Demographics
NPI:1700024825
Name:CROSSROADS-HOLLOWAY HEALTH CLINIC LLC
Entity Type:Organization
Organization Name:CROSSROADS-HOLLOWAY HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:TOSSPON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-339-7038
Mailing Address - Street 1:12805 HIGHWAY 28 EAST SUITE B
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360
Mailing Address - Country:US
Mailing Address - Phone:318-466-5151
Mailing Address - Fax:318-466-3535
Practice Address - Street 1:12805 HIGHWAY 28 EAST
Practice Address - Street 2:SUITE B
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360
Practice Address - Country:US
Practice Address - Phone:318-466-5151
Practice Address - Fax:318-466-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health