MEDICARE: CROSS ROADS RESOLUTIONS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	043195	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z118C	OTHER	FL	BLUECROSS BLUESHIELD

General Provider Information

NPI Number	:	1033273925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSS ROADS RESOLUTIONS, INC

Provider Business Mailing Address
First Line	:	PO BOX 487
Second Line	:
City	:	IMMOKALEE
State	:	FL
Zip	:	34143-0487
Country	:	US
Telephone Number	:
Fax Number	:	239-303-3100

Provider Business Practice Location Address
First Line	:	1120 HOMESTEAD RD N
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33936-6044
Country	:	US
Telephone Number	:	239-281-8903
Fax Number	:	239-303-3100

Authorized Official
Title or Position	:	OWNER
Name	:	SHIRLEY SLOAN
Credential	:	LCSW
Telephone Number	:	239-281-8903

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	03/28/2011

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Directions to “CROSS ROADS RESOLUTIONS, INC ” Practice Location

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