Provider Demographics
NPI:1841735750
Name:CROSSROADS ADDICTION SERVICES, INC
Entity Type:Organization
Organization Name:CROSSROADS ADDICTION SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BIEMER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:772-242-5408
Mailing Address - Street 1:1420 SW SAINT LUCIE WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1709
Mailing Address - Country:US
Mailing Address - Phone:772-242-5408
Mailing Address - Fax:
Practice Address - Street 1:1420 SW SAINT LUCIE WEST BLVD STE 106
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1709
Practice Address - Country:US
Practice Address - Phone:772-242-5408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-31
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1982716353OtherPROVIDER NPI-T. BIEMER
1477580876OtherMEDICAL DIRECTOR PROVIDER NPI-M. ADLEN
1861729824OtherPROVIDER NPI-V. FERRARA
1982716353OtherPROVIDER NPI-T. BIEMER