Provider Demographics
NPI:1528091063
Name:CROSSROADS SERVICES BOARD
Entity type:Organization
Organization Name:CROSSROADS SERVICES BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-392-7049
Mailing Address - Street 1:P.O. DRAWER 248
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901
Mailing Address - Country:US
Mailing Address - Phone:434-392-7049
Mailing Address - Fax:434-392-9221
Practice Address - Street 1:60 BUSH RIVER DRIVE
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901
Practice Address - Country:US
Practice Address - Phone:434-392-7049
Practice Address - Fax:434-392-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945450Medicaid
VA260000119Medicare UPIN
VA800002799Medicare UPIN
VA004945450Medicaid
VA007135C10Medicare UPIN
VAC01211Medicare PIN
VAC06378Medicare PIN
VAC01210Medicare PIN
VA800002554Medicare UPIN
VA800001017Medicare UPIN