Provider Demographics
NPI:1932863099
Name:CROSSTREE HEALTHCARE LLC
Entity Type:Organization
Organization Name:CROSSTREE HEALTHCARE LLC
Other - Org Name:THE HAVEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-217-8669
Mailing Address - Street 1:612 SOUTH BYP
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-3240
Mailing Address - Country:US
Mailing Address - Phone:573-217-8669
Mailing Address - Fax:
Practice Address - Street 1:614 SOUTH BYP
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-3240
Practice Address - Country:US
Practice Address - Phone:573-217-8669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility