Healthcare Provider Details

I. General information

NPI: 1245886415
Provider Name (Legal Business Name): CROSSROADS, INC PURE HEART COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14240 N 43RD AVE
GLENDALE AZ
85306-4511
US

IV. Provider business mailing address

2002 E OSBORN RD
PHOENIX AZ
85016-7236
US

V. Phone/Fax

Practice location:
  • Phone: 602-263-5242
  • Fax: 602-595-4434
Mailing address:
  • Phone: 602-263-5242
  • Fax: 602-595-4434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: CHRIS RILEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 602-263-5242