Healthcare Provider Details

I. General information

NPI: 1336884345
Provider Name (Legal Business Name): CROSSROAD HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 CEDAR AVE S STE 6
MINNEAPOLIS MN
55454-1086
US

IV. Provider business mailing address

326 CEDAR AVE S STE 6
MINNEAPOLIS MN
55454-1086
US

V. Phone/Fax

Practice location:
  • Phone: 612-444-9927
  • Fax:
Mailing address:
  • Phone: 612-444-9927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FAYSAL MOHAMED
Title or Position: PRESIDENT
Credential:
Phone: 612-444-9927