Provider Demographics
NPI:1104085984
Name:CROSSROADS TREATMENT CENTER, LLC
Entity type:Organization
Organization Name:CROSSROADS TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUPERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MCCORMAC
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:864-270-6860
Mailing Address - Street 1:6 ROBERTS RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-8613
Mailing Address - Country:US
Mailing Address - Phone:828-505-3086
Mailing Address - Fax:
Practice Address - Street 1:6 ROBERTS RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-8613
Practice Address - Country:US
Practice Address - Phone:828-505-3086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TREATMENT CENTERS HOLDCO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRC03368490261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone