Provider Demographics
NPI:1215912290
Name:CROSSROADS REHABILITATION
Entity type:Organization
Organization Name:CROSSROADS REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:GRAYSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:318-255-1702
Mailing Address - Street 1:3005 ENGLISH TURN
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-2668
Mailing Address - Country:US
Mailing Address - Phone:318-255-1702
Mailing Address - Fax:318-624-9299
Practice Address - Street 1:1745 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:HAYNESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71038-5411
Practice Address - Country:US
Practice Address - Phone:318-624-9299
Practice Address - Fax:318-624-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty