Provider Demographics
NPI:1912061508
Name:CROSSROADS RESCUE MISSION
Entity Type:Organization
Organization Name:CROSSROADS RESCUE MISSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GARLIT
Authorized Official - Suffix:
Authorized Official - Credentials:LISAC
Authorized Official - Phone:928-783-9362
Mailing Address - Street 1:P.O. BOX 1161
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366
Mailing Address - Country:US
Mailing Address - Phone:928-726-0491
Mailing Address - Fax:928-314-0717
Practice Address - Street 1:944 S ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-3947
Practice Address - Country:US
Practice Address - Phone:928-783-9362
Practice Address - Fax:928-329-6020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-1142324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility