Healthcare Provider Details

I. General information

NPI: 1770016610
Provider Name (Legal Business Name): CROSSROADS TREATMENT CENTER OF SAN ANTONIO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 06/18/2022
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 CRESTWAY DR SUITE 200B
SAN ANTONIO TX
78239-1980
US

IV. Provider business mailing address

200 E BROAD ST STE 300
GREENVILLE SC
29601-2891
US

V. Phone/Fax

Practice location:
  • Phone: 210-310-3864
  • Fax:
Mailing address:
  • Phone: 800-805-6989
  • Fax: 864-558-8511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEGAN THOMS
Title or Position: OPERATIONS SPECIALIST FOR STRATEGIC
Credential:
Phone: 800-805-6989