Provider Demographics
NPI:1104600907
Name:CROSSROADS GENIUS CAMPERS, INC.
Entity type:Organization
Organization Name:CROSSROADS GENIUS CAMPERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:346-291-8205
Mailing Address - Street 1:6031 VICTORY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-6636
Mailing Address - Country:US
Mailing Address - Phone:346-291-8205
Mailing Address - Fax:
Practice Address - Street 1:6031 VICTORY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-6636
Practice Address - Country:US
Practice Address - Phone:346-291-8205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101200000XBehavioral Health & Social Service ProvidersDrama TherapistGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)