Provider Demographics
NPI:1063611572
Name:CROSSROADS HOSPICE, INC.
Entity type:Organization
Organization Name:CROSSROADS HOSPICE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:DEWBRE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-534-0716
Mailing Address - Street 1:30600 NORTHWESTERN HWY STE 245
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3171
Mailing Address - Country:US
Mailing Address - Phone:248-957-1999
Mailing Address - Fax:888-990-0589
Practice Address - Street 1:8582 KATY FWY STE 225
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024
Practice Address - Country:US
Practice Address - Phone:888-791-6770
Practice Address - Fax:832-280-6776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001016928Medicaid
TX001016928Medicaid