Provider Demographics
NPI:1245861632
Name:CROSSROADS CENTRE ANTIGUA
Entity type:Organization
Organization Name:CROSSROADS CENTRE ANTIGUA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMISSION
Authorized Official - Prefix:
Authorized Official - First Name:JEAN-MACHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENN-DUBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LPC NCC ACS
Authorized Official - Phone:888-452-0091
Mailing Address - Street 1:41 MADISON AVE FL 38
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WILLOUGH BAY
Practice Address - Street 2:
Practice Address - City:ST JOHN'S
Practice Address - State:ANTIGUA AND BARBUDA
Practice Address - Zip Code:WEST INDIES
Practice Address - Country:AG
Practice Address - Phone:268-562-3278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-04
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility