Provider Demographics
NPI:1386265148
Name:CROSSROADS RECOVERY HOUSE
Entity type:Organization
Organization Name:CROSSROADS RECOVERY HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:CIT
Authorized Official - Phone:337-255-8742
Mailing Address - Street 1:10377 GOODWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-4526
Mailing Address - Country:US
Mailing Address - Phone:337-255-8742
Mailing Address - Fax:
Practice Address - Street 1:10377 GOODWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4526
Practice Address - Country:US
Practice Address - Phone:337-255-8742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000OtherNO ISSUER YET, WAITING ON NPI TO APPLY TO BE SERVICE PROVIDER FOR MEDICAID