Healthcare Provider Details

I. General information

NPI: 1417088816
Provider Name (Legal Business Name): CROSSROADS LA. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3719 GENERAL DEGAULLE DR
NEW ORLEANS LA
70114-8205
US

IV. Provider business mailing address

625 OLIVIER ST
NEW ORLEANS LA
70114-1046
US

V. Phone/Fax

Practice location:
  • Phone: 504-366-1828
  • Fax: 504-366-1867
Mailing address:
  • Phone: 504-366-1828
  • Fax: 504-366-1867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number10208
License Number StateLA

VIII. Authorized Official

Name: BEVERLY DUNCAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 504-366-1828