Provider Demographics
NPI:1740600410
Name:CROSSROADS CENTER FOR RECOVERY
Entity Type:Organization
Organization Name:CROSSROADS CENTER FOR RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:989-391-9900
Mailing Address - Street 1:1001 MULHOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-7646
Mailing Address - Country:US
Mailing Address - Phone:989-391-9900
Mailing Address - Fax:989-497-1530
Practice Address - Street 1:1001 MULHOLLAND ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-7646
Practice Address - Country:US
Practice Address - Phone:989-391-9900
Practice Address - Fax:989-497-1530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health