Provider Demographics
NPI:1821294109
Name:CROSSROADS NURSING SERVICE, INC
Entity Type:Organization
Organization Name:CROSSROADS NURSING SERVICE, INC
Other - Org Name:CROSSROADS NURSING SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SPICAK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:361-578-3621
Mailing Address - Street 1:1910 COMMERCE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5510
Mailing Address - Country:US
Mailing Address - Phone:361-578-3621
Mailing Address - Fax:361-573-6952
Practice Address - Street 1:1910 COMMERCE ST STE 200
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5510
Practice Address - Country:US
Practice Address - Phone:361-578-3621
Practice Address - Fax:361-573-6952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00707251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health