Healthcare Provider Details

I. General information

NPI: 1801922869
Provider Name (Legal Business Name): TAMPA CROSSROADS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 3RD ST N
SAINT PETERSBURG FL
33701-2908
US

IV. Provider business mailing address

5118 N NEBRASKA AVE
TAMPA FL
33603-2363
US

V. Phone/Fax

Practice location:
  • Phone: 727-898-0088
  • Fax:
Mailing address:
  • Phone: 813-238-5210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberSR52AD371903
License Number StateFL

VIII. Authorized Official

Name: MRS. SARA ROMEO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 813-238-5210