Provider Demographics
NPI:1184043770
Name:CROSSROADS ADULT DAYCARE CENTER, INC
Entity type:Organization
Organization Name:CROSSROADS ADULT DAYCARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-333-0059
Mailing Address - Street 1:1011 HOMELAND AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-7003
Mailing Address - Country:US
Mailing Address - Phone:336-333-0059
Mailing Address - Fax:336-273-0456
Practice Address - Street 1:1011 HOMELAND AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-7003
Practice Address - Country:US
Practice Address - Phone:336-333-0059
Practice Address - Fax:336-273-0456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services