Healthcare Provider Details

I. General information

NPI: 1104085984
Provider Name (Legal Business Name): CROSSROADS TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 ROBERTS RD SUITE 103
ASHEVILLE NC
28803-8613
US

IV. Provider business mailing address

6 ROBERTS RD SUITE 103
ASHEVILLE NC
28803-8613
US

V. Phone/Fax

Practice location:
  • Phone: 828-505-3086
  • Fax:
Mailing address:
  • Phone: 828-505-3086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License NumberRC03368490
License Number StateNC

VIII. Authorized Official

Name: DR. RUPERT JAMES MCCORMAC IV
Title or Position: PRESIDENT
Credential: M.D.
Phone: 864-270-6860