Provider Demographics
NPI:1194690628
Name:CROSSROADS HEALTHCARE LLC
Entity type:Organization
Organization Name:CROSSROADS HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINNY
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:662-252-9417
Mailing Address - Street 1:153 ISOM CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:38635-9207
Mailing Address - Country:US
Mailing Address - Phone:662-252-9417
Mailing Address - Fax:
Practice Address - Street 1:153 ISOM CHAPEL RD
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:38635-9207
Practice Address - Country:US
Practice Address - Phone:662-252-9417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-06
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty