Provider Demographics
NPI:1811626559
Name:CROSSROADS WELLNESS LLC
Entity Type:Organization
Organization Name:CROSSROADS WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:DEVAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-484-6408
Mailing Address - Street 1:17331 BUSHLAND RD
Mailing Address - Street 2:
Mailing Address - City:PARKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21120-9476
Mailing Address - Country:US
Mailing Address - Phone:443-484-6408
Mailing Address - Fax:
Practice Address - Street 1:1103 N STRICKER ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-2241
Practice Address - Country:US
Practice Address - Phone:410-697-5502
Practice Address - Fax:410-457-9420
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CROSSROADS WELLNESS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-08
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation