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NPI Code Detail

MEDICARE: CROSSROADS TREATMENT CENTER OF CLEVELAND COUNTY, PC

MEDICARE: CROSSROADS TREATMENT CENTER OF CLEVELAND COUNTY, PC
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
1251S00000XCommunity/Behavioral Health AgencyNC
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
3261QM1300XMulti-Specialty Clinic/Center
4261QM2800XMethadone ClinicNC
5261QP2300XPrimary Care Clinic/Center
6261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number : 1609370568
Entity Type Code : Organization
Provider Name (Legal Business Name) : CROSSROADS TREATMENT CENTER OF CLEVELAND COUNTY, PC
Provider Business Mailing Address
First Line : 200 E BROAD ST STE 300
Second Line :
City : GREENVILLE
State : SC
Zip : 29601-2891
Country : US
Telephone Number : 800-805-6989
Fax Number : 864-558-8511
Provider Business Practice Location Address
First Line : 1895 E DIXON BLVD
Second Line :
City : SHELBY
State : NC
Zip : 28152-6901
Country : US
Telephone Number : 704-466-3970
Fax Number : 704-600-6011
Authorized Official
Title or Position : CEO
Name : RUPERT JAMES MCCORMAC
Credential : MD
Telephone Number : 800-805-6989
Provider Enumeration Date : 03/23/2018
Last Update Date : 06/18/2022

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