Provider Demographics
NPI:1821511064
Name:CROSS ROAD HEALTH MINISTRIES, INC.
Entity Type:Organization
Organization Name:CROSS ROAD HEALTH MINISTRIES, INC.
Other - Org Name:CROSS ROAD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-822-5686
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:GLENNALLEN
Mailing Address - State:AK
Mailing Address - Zip Code:99588-0589
Mailing Address - Country:US
Mailing Address - Phone:907-822-3203
Mailing Address - Fax:
Practice Address - Street 1:187 GLENN HIGHWAY
Practice Address - Street 2:
Practice Address - City:GLENNALLEN
Practice Address - State:AK
Practice Address - Zip Code:99588-0589
Practice Address - Country:US
Practice Address - Phone:907-822-3203
Practice Address - Fax:907-822-3203
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CROSS ROAD HEALTH MINISTRIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-19
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)