Healthcare Provider Details

I. General information

NPI: 1619028909
Provider Name (Legal Business Name): CROSSROADS COUNSELING & TRAINING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 PEGER RD SUITE 200
FAIRBANKS AK
99709-5484
US

IV. Provider business mailing address

PO BOX 82074
FAIRBANKS AK
99708-2074
US

V. Phone/Fax

Practice location:
  • Phone: 907-455-9737
  • Fax:
Mailing address:
  • Phone: 907-455-9737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberHC5957
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberHC5957
License Number StateAK

VIII. Authorized Official

Name: MS. NICOLE NELSON
Title or Position: EXECUTIVE DIRECTOR
Credential: MPS
Phone: 907-455-9737