Healthcare Provider Details

I. General information

NPI: 1184325953
Provider Name (Legal Business Name): CROSSROADS TREATMENT CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2023
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 ISLETA BLVD SW
ALBUQUERQUE NM
87105-4635
US

IV. Provider business mailing address

8205 DESERT LILY LN NE
ALBUQUERQUE NM
87122-3658
US

V. Phone/Fax

Practice location:
  • Phone: 505-390-8383
  • Fax: 505-390-5407
Mailing address:
  • Phone: 505-228-1518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DARREN T WEBB
Title or Position: OWNER
Credential:
Phone: 505-228-1518