Provider Demographics
NPI:1891193413
Name:CROSSROADS AT CATAWBA, LLC
Entity Type:Organization
Organization Name:CROSSROADS AT CATAWBA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-714-5439
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:CATAWBA
Mailing Address - State:SC
Mailing Address - Zip Code:29704-0065
Mailing Address - Country:US
Mailing Address - Phone:803-329-3377
Mailing Address - Fax:803-329-0933
Practice Address - Street 1:400 ROWELLS RD
Practice Address - Street 2:
Practice Address - City:CATAWBA
Practice Address - State:SC
Practice Address - Zip Code:29704-8769
Practice Address - Country:US
Practice Address - Phone:803-329-3377
Practice Address - Fax:803-329-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-13
Last Update Date:2014-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCRC-0743310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility