Healthcare Provider Details

I. General information

NPI: 1750891396
Provider Name (Legal Business Name): CROSSROADS TREATMENT CENTER OF PLYMOUTH, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 LONG POND RD STE 2-3
PLYMOUTH MA
02360-2663
US

IV. Provider business mailing address

55 BEATTIE PL STE 810
GREENVILLE SC
29601-2191
US

V. Phone/Fax

Practice location:
  • Phone: 774-773-3905
  • Fax: 774-773-9623
Mailing address:
  • Phone: 864-527-3145
  • Fax: 864-990-0653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: RUPERT MCCORMAC IV
Title or Position: PRESIDENT
Credential: MD
Phone: 864-527-3145