Provider Demographics
NPI:1811676257
Name:J&A CROSSROADS LLC
Entity type:Organization
Organization Name:J&A CROSSROADS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CSWA
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:ARLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-329-5573
Mailing Address - Street 1:8133 NE BEECH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-7121
Mailing Address - Country:US
Mailing Address - Phone:503-329-5573
Mailing Address - Fax:
Practice Address - Street 1:524 N TILLAMOOK ST STE 102B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1993
Practice Address - Country:US
Practice Address - Phone:503-329-5573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty