Healthcare Provider Details

I. General information

NPI: 1396174926
Provider Name (Legal Business Name): CROSSROADS FOR WOMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1632 E FLOWER ST
PHOENIX AZ
85016-7115
US

IV. Provider business mailing address

2002 E OSBORN RD
PHOENIX AZ
85016-7236
US

V. Phone/Fax

Practice location:
  • Phone: 602-274-0730
  • Fax:
Mailing address:
  • Phone: 602-263-5242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberBH-2811
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberBH-2811
License Number StateAZ

VIII. Authorized Official

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