Provider Demographics
NPI:1972662328
Name:COMMUNITY CROSSROADS, INC.
Entity Type:Organization
Organization Name:COMMUNITY CROSSROADS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-893-1299
Mailing Address - Street 1:8 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:ATKINSON
Mailing Address - State:NH
Mailing Address - Zip Code:03811-2191
Mailing Address - Country:US
Mailing Address - Phone:603-893-1299
Mailing Address - Fax:603-893-5401
Practice Address - Street 1:8 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:ATKINSON
Practice Address - State:NH
Practice Address - Zip Code:03811
Practice Address - Country:US
Practice Address - Phone:603-893-1299
Practice Address - Fax:603-893-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH251B00000X, 251C00000X, 251V00000X, 320900000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251V00000XAgenciesVoluntary or Charitable
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH60000010Medicaid
NH99560010Medicaid
NH30006118Medicaid
NH99560060Medicaid
NH99590010Medicaid