Healthcare Provider Details

I. General information

NPI: 1639362957
Provider Name (Legal Business Name): CROSSROADS SLEEP DISORDERS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 07/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 BOARDMAN POLAND RD SUITE 204
BOARDMAN OH
44512-5107
US

IV. Provider business mailing address

721 BOARDMAN-POLAND RD SUITE 204
BOARDMAN OH
44512
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-0220
  • Fax: 330-965-9622
Mailing address:
  • Phone: 330-965-0220
  • Fax: 330-965-9622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number35-084112
License Number StateOH

VIII. Authorized Official

Name: MRS. DONNA CROWE
Title or Position: OFFICE MANAGER
Credential:
Phone: 330-965-0220