Healthcare Provider Details

I. General information

NPI: 1679741128
Provider Name (Legal Business Name): CROSSROADS HOSPICE OF DAYTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8069 WASHINGTON VILLAGE DR
DAYTON OH
45458-1847
US

IV. Provider business mailing address

10810 E 45TH ST STE 300
TULSA OK
74146-3816
US

V. Phone/Fax

Practice location:
  • Phone: 937-312-3170
  • Fax: 937-439-5903
Mailing address:
  • Phone: 918-627-6846
  • Fax: 918-627-6856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number0168HSP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. CLAYTON FARMER
Title or Position: CFO/COO
Credential:
Phone: 918-627-6846