Provider Demographics
NPI:1285775460
Name:CROSSROADS BEHAVIORAL HEALTH CENTER, INC.
Entity type:Organization
Organization Name:CROSSROADS BEHAVIORAL HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FINER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW MCAP
Authorized Official - Phone:239-692-1020
Mailing Address - Street 1:3606 ENTERPRISE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-3670
Mailing Address - Country:US
Mailing Address - Phone:239-692-1020
Mailing Address - Fax:239-330-7168
Practice Address - Street 1:3606 ENTERPRISE AVE STE 300
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-3670
Practice Address - Country:US
Practice Address - Phone:239-692-1020
Practice Address - Fax:239-330-7168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 261QM0801X
FL2601261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL767646800Medicaid