Healthcare Provider Details

I. General information

NPI: 1811858996
Provider Name (Legal Business Name): NATIONAL CROSSROADS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4990 HOLLY DR
SAN DIEGO CA
92113-2059
US

IV. Provider business mailing address

4991 IMPERIAL AVE
SAN DIEGO CA
92113-2063
US

V. Phone/Fax

Practice location:
  • Phone: 619-262-0868
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. LESLIE LAKE
Title or Position: DIRECTOR
Credential:
Phone: 713-530-4728