Provider Demographics
NPI:1700531928
Name:CROSSROADS COMMUNITY COMMUNITY HEALTH CARE, LLC
Entity type:Organization
Organization Name:CROSSROADS COMMUNITY COMMUNITY HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:DITTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:307-231-6853
Mailing Address - Street 1:1325 PALISADES WAY
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-7323
Mailing Address - Country:US
Mailing Address - Phone:307-231-6853
Mailing Address - Fax:
Practice Address - Street 1:1325 PALISADES WAY
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-7323
Practice Address - Country:US
Practice Address - Phone:307-231-6853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty