Provider Demographics
NPI:1952156424
Name:CROSSROADS ALLIANCE INC
Entity Type:Organization
Organization Name:CROSSROADS ALLIANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:MUHAMMAD
Authorized Official - Last Name:RAFIQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-565-2998
Mailing Address - Street 1:2019 W HIGH RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-8143
Mailing Address - Country:US
Mailing Address - Phone:847-565-2998
Mailing Address - Fax:
Practice Address - Street 1:2019 W HIGH RIDGE DR
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073-8143
Practice Address - Country:US
Practice Address - Phone:847-565-2998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies