Healthcare Provider Details

I. General information

NPI: 1528154895
Provider Name (Legal Business Name): CROSSROADS HEALING ARTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21764 OMEGA CT
GOSHEN IN
46528-7809
US

IV. Provider business mailing address

3700 52ND ST SE
GRAND RAPIDS MI
49512-9637
US

V. Phone/Fax

Practice location:
  • Phone: 574-875-4227
  • Fax: 574-875-7828
Mailing address:
  • Phone: 616-656-3700
  • Fax: 616-656-3701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMMY L GEURKINK BORN
Title or Position: OWNER
Credential: DO
Phone: 616-656-3700