Healthcare Provider Details

I. General information

NPI: 1609871391
Provider Name (Legal Business Name): CROSS ROAD HEALTH MINISTRIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MILE 187 GLENN HIGHWAY
GLENNALLEN AK
99588-0589
US

IV. Provider business mailing address

PO BOX 5
GLENNALLEN AK
99588-0589
US

V. Phone/Fax

Practice location:
  • Phone: 907-822-3203
  • Fax: 907-822-5805
Mailing address:
  • Phone: 907-822-5686
  • Fax: 907-822-5684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number10300
License Number StateAK

VIII. Authorized Official

Name: STEVEN WILLIAM GALLAGHER
Title or Position: CEO
Credential:
Phone: 907-822-5686