Provider Demographics
NPI:1649333113
Name:CROSSROADS BEHAVIORAL HEALTHCARE
Entity type:Organization
Organization Name:CROSSROADS BEHAVIORAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-835-1000
Mailing Address - Street 1:200 ELKIN BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-3159
Mailing Address - Country:US
Mailing Address - Phone:336-835-1000
Mailing Address - Fax:336-835-1002
Practice Address - Street 1:200 ELKIN BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-3159
Practice Address - Country:US
Practice Address - Phone:336-835-1000
Practice Address - Fax:336-835-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404916Medicaid