Healthcare Provider Details

I. General information

NPI: 1245376425
Provider Name (Legal Business Name): CROSSROADS OF HOPE,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12266 STATE ROUTE 5
ASHLAND KY
41102-8099
US

IV. Provider business mailing address

12266 STATE ROUTE 5
ASHLAND KY
41102-8099
US

V. Phone/Fax

Practice location:
  • Phone: 606-928-0177
  • Fax: 606-928-0133
Mailing address:
  • Phone: 606-928-0177
  • Fax: 606-928-0133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: VALERIE A FRASURE
Title or Position: EXECUTIVE DIRECTOR
Credential: ED,RN
Phone: 606-928-2883