Provider Demographics
NPI:1669698676
Name:CROSSROADS, INC.
Entity type:Organization
Organization Name:CROSSROADS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:SKOLNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BSW
Authorized Official - Phone:203-387-0094
Mailing Address - Street 1:44 E RAMSDELL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-1140
Mailing Address - Country:US
Mailing Address - Phone:203-387-0094
Mailing Address - Fax:203-907-4513
Practice Address - Street 1:44 EAST RAMSDELL ST.
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1140
Practice Address - Country:US
Practice Address - Phone:203-387-0094
Practice Address - Fax:203-907-4513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0402, 0336251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCTGA000503OtherGENERAL ASSISTANCE
CT004238251Medicaid