MEDICARE: CROSSROADS WEST

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1376107292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSROADS WEST

Provider Business Mailing Address
First Line	:	2002 E OSBORN RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7236
Country	:	US
Telephone Number	:	602-263-5242
Fax Number	:	602-595-4434

Provider Business Practice Location Address
First Line	:	7523 N 35TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-7422
Country	:	US
Telephone Number	:	602-263-5242
Fax Number	:	602-595-4434

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. CHRIS RILEY
Credential	:
Telephone Number	:	602-263-5242

Provider Enumeration Date	:	04/25/2019
Last Update Date	:	06/05/2025

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Directions to “CROSSROADS WEST ” Practice Location

Language	Start Address	Practice Location

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