Healthcare Provider Details

I. General information

NPI: 1518228519
Provider Name (Legal Business Name): THE CROSSROADS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 MARTIN LUTHER KING DR E
CINCINNATI OH
45220
US

IV. Provider business mailing address

311 MARTIN LUTHER KING DR E
CINCINNATI OH
45220
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-5300
  • Fax: 513-475-5394
Mailing address:
  • Phone: 513-475-5300
  • Fax: 513-475-5394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number0315
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number0315
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number0315
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number0315
License Number StateOH

VIII. Authorized Official

Name: MS. ELIZABETH OSINBOWALE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MSW, LISW-S, LICDC-S
Phone: 513-475-5300