Healthcare Provider Details

I. General information

NPI: 1497277800
Provider Name (Legal Business Name): CROSSROADS PROGRAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 07/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 DELAWARE AVE
EWING NJ
08628-2003
US

IV. Provider business mailing address

610 BEVERLY RANCOCAS RD
WILLINGBORO NJ
08046-3736
US

V. Phone/Fax

Practice location:
  • Phone: 609-880-0210
  • Fax:
Mailing address:
  • Phone: 609-880-0210
  • Fax: 609-880-0230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT MICHAEL KOPCHO
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 609-880-0210