Provider Demographics
NPI:1386323863
Name:CROSSROADS COMMUNITY
Entity type:Organization
Organization Name:CROSSROADS COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:260-301-4501
Mailing Address - Street 1:PO BOX 222
Mailing Address - Street 2:
Mailing Address - City:BERNE
Mailing Address - State:IN
Mailing Address - Zip Code:46711-0222
Mailing Address - Country:US
Mailing Address - Phone:260-301-4501
Mailing Address - Fax:
Practice Address - Street 1:524 W HOOSIER ST
Practice Address - Street 2:
Practice Address - City:BERNE
Practice Address - State:IN
Practice Address - Zip Code:46711-1019
Practice Address - Country:US
Practice Address - Phone:260-301-4501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No177F00000XOther Service ProvidersLodging