Healthcare Provider Details

I. General information

NPI: 1396251229
Provider Name (Legal Business Name): CROSSROADS RECOVERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2017
Last Update Date: 09/02/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 MAIN ST
SALEM NH
03079-3196
US

IV. Provider business mailing address

155 MAIN ST
SALEM NH
03079-3196
US

V. Phone/Fax

Practice location:
  • Phone: 603-912-4490
  • Fax: 603-824-6935
Mailing address:
  • Phone: 603-912-4490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BARRY PIETRANTONIO
Title or Position: CEO
Credential: LCMHC
Phone: 603-912-4490