Provider Demographics
NPI:1720471220
Name:CROSSROADS CARING HOME
Entity Type:Organization
Organization Name:CROSSROADS CARING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-768-9672
Mailing Address - Street 1:2563 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CARYVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32427-2013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2563 RIVER ROAD
Practice Address - Street 2:
Practice Address - City:CARYVILLE
Practice Address - State:FL
Practice Address - Zip Code:32427
Practice Address - Country:US
Practice Address - Phone:850-535-4267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL126303104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness