Provider Demographics
NPI:1730378985
Name:CROSSROADS ADOLESCENT AND ADULT COMMUNITY SUPPORT SERVICES, LLC
Entity type:Organization
Organization Name:CROSSROADS ADOLESCENT AND ADULT COMMUNITY SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:919-672-7076
Mailing Address - Street 1:916 LAMOND AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-2019
Mailing Address - Country:US
Mailing Address - Phone:919-672-7076
Mailing Address - Fax:919-471-8564
Practice Address - Street 1:916 LAMOND AVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-2019
Practice Address - Country:US
Practice Address - Phone:919-672-7076
Practice Address - Fax:919-471-8564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health