Provider Demographics
NPI:1700391703
Name:CROSSROADS HEALTHCARE, LLC
Entity Type:Organization
Organization Name:CROSSROADS HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:DEATON
Authorized Official - Last Name:REDDING
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:706-577-5676
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:AL
Mailing Address - Zip Code:36874-0189
Mailing Address - Country:US
Mailing Address - Phone:706-577-5676
Mailing Address - Fax:
Practice Address - Street 1:867 LEE ROAD 248
Practice Address - Street 2:
Practice Address - City:SMITHS STATION
Practice Address - State:AL
Practice Address - Zip Code:36877-3295
Practice Address - Country:US
Practice Address - Phone:334-291-5328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1147693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL114769OtherALABAMA PHARMACY LICENSE