Healthcare Provider Details

I. General information

NPI: 1558451351
Provider Name (Legal Business Name): CROSSROAD INTEGRATED SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8514 ARTESIA BLVD
BELLFLOWER CA
90706-6102
US

IV. Provider business mailing address

8514 ARTESIA BLVD
BELLFLOWER CA
90706-6102
US

V. Phone/Fax

Practice location:
  • Phone: 562-272-8007
  • Fax: 562-272-0150
Mailing address:
  • Phone: 562-272-8007
  • Fax: 562-272-0150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. THELMA I. TEVES
Title or Position: ADMINISTRATOR
Credential:
Phone: 562-272-8007