Provider Demographics
NPI:1730636812
Name:CROSSROADS HEALTH LLC
Entity Type:Organization
Organization Name:CROSSROADS HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:WOOD NEESON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:307-751-0645
Mailing Address - Street 1:PO BOX 7221
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-7004
Mailing Address - Country:US
Mailing Address - Phone:307-751-0645
Mailing Address - Fax:
Practice Address - Street 1:1842 SUGARLAND DR
Practice Address - Street 2:SUITE 103
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5775
Practice Address - Country:US
Practice Address - Phone:307-751-0645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY19472.0369261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care