Provider Demographics
NPI: | 1457359838 |
---|---|
Name: | CROSSROADS REHABILITATION CENTER, INC. |
Entity type: | Organization |
Organization Name: | CROSSROADS REHABILITATION CENTER, INC. |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | JAMES |
Authorized Official - Middle Name: | PATRICK |
Authorized Official - Last Name: | SANDY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 317-466-2015 |
Mailing Address - Street 1: | 4740 KINGSWAY DR |
Mailing Address - Street 2: | |
Mailing Address - City: | INDIANAPOLIS |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46205-1521 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 317-466-1000 |
Mailing Address - Fax: | 317-466-2000 |
Practice Address - Street 1: | 4740 KINGSWAY DR |
Practice Address - Street 2: | |
Practice Address - City: | INDIANAPOLIS |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46205-1521 |
Practice Address - Country: | US |
Practice Address - Phone: | 317-466-1000 |
Practice Address - Fax: | 317-466-2000 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2005-07-11 |
Last Update Date: | 2013-07-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225400000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 225XR0403X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Driving and Community Mobility | Group - Multi-Specialty |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 100462120 | Medicaid | |
IN | 100462120 | Medicaid |