Provider Demographics
NPI:1750891396
Name:CROSSROADS TREATMENT CENTER OF PLYMOUTH, PC
Entity type:Organization
Organization Name:CROSSROADS TREATMENT CENTER OF PLYMOUTH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUPERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMAC
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:864-527-3145
Mailing Address - Street 1:55 BEATTIE PL STE 810
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2191
Mailing Address - Country:US
Mailing Address - Phone:864-527-3145
Mailing Address - Fax:864-990-0653
Practice Address - Street 1:116 LONG POND RD STE 2-3
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2663
Practice Address - Country:US
Practice Address - Phone:774-773-3905
Practice Address - Fax:774-773-9623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No251S00000XAgenciesCommunity/Behavioral Health