Provider Demographics
NPI:1508579525
Name:CROSSTREE HEALTHCARE THE RANCH,LLC
Entity Type:Organization
Organization Name:CROSSTREE HEALTHCARE THE RANCH,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:618-263-7071
Mailing Address - Street 1:935 S 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:PIGGOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72454-3134
Mailing Address - Country:US
Mailing Address - Phone:618-263-7071
Mailing Address - Fax:
Practice Address - Street 1:18839 HUMMINGBIRD LN
Practice Address - Street 2:
Practice Address - City:MARBLE HILL
Practice Address - State:MO
Practice Address - Zip Code:63764-5882
Practice Address - Country:US
Practice Address - Phone:573-238-4253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness