Healthcare Provider Details

I. General information

NPI: 1790208379
Provider Name (Legal Business Name): CROSSBRIDGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 07/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 RIVER RD S STE 100
SALEM OR
97302-9819
US

IV. Provider business mailing address

5123 S MORROW ST
BOISE ID
83709-5254
US

V. Phone/Fax

Practice location:
  • Phone: 800-541-3732
  • Fax: 503-585-3267
Mailing address:
  • Phone: 800-541-3732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RENEE NAYLOR
Title or Position: OWNER
Credential:
Phone: 503-362-5235