Provider Demographics
NPI:1730351925
Name:CROSSROADS FAMILY SERVICES II LLC
Entity type:Organization
Organization Name:CROSSROADS FAMILY SERVICES II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:LM
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-285-5562
Mailing Address - Street 1:PO BOX 10084
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-0084
Mailing Address - Country:US
Mailing Address - Phone:757-285-5562
Mailing Address - Fax:757-399-3355
Practice Address - Street 1:2602 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-4245
Practice Address - Country:US
Practice Address - Phone:757-285-5562
Practice Address - Fax:757-399-3355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA51014001320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness