Provider Demographics
NPI:1861775058
Name:CROSSROADS REHABILITATION LLC
Entity type:Organization
Organization Name:CROSSROADS REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRAYSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:318-927-4987
Mailing Address - Street 1:207 N SERVICE RD E
Mailing Address - Street 2:PMB 207
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-2805
Mailing Address - Country:US
Mailing Address - Phone:318-927-4987
Mailing Address - Fax:318-927-4987
Practice Address - Street 1:123 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:LA
Practice Address - Zip Code:71040-4435
Practice Address - Country:US
Practice Address - Phone:318-927-4987
Practice Address - Fax:318-927-4987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty