Healthcare Provider Details

I. General information

NPI: 1043087174
Provider Name (Legal Business Name): CROSSROADS TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367 RICHARDSON RD SE
CALHOUN GA
30701-3619
US

IV. Provider business mailing address

367 RICHARDSON RD SE
CALHOUN GA
30701-3619
US

V. Phone/Fax

Practice location:
  • Phone: 800-805-6989
  • Fax:
Mailing address:
  • Phone: 800-805-6989
  • Fax: 762-204-1225

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

VIII. Authorized Official

Name: LOUELLA ARMSTRONG
Title or Position: COUNSELOR
Credential: CADC T
Phone: 706-591-9597