Healthcare Provider Details

I. General information

NPI: 1710208764
Provider Name (Legal Business Name): CROSSING PATHS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10441 MIDLOTHIAN TPKE
RICHMOND VA
23235-4407
US

IV. Provider business mailing address

931 JEFFERSON BLVD SUITE 2001
WARWICK RI
02886-2234
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-6915
  • Fax: 804-320-6917
Mailing address:
  • Phone: 401-921-3320
  • Fax: 401-921-3327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number2101001253
License Number StateVA

VIII. Authorized Official

Name: MR. BRUCE MEDEIROS
Title or Position: CONTROLLER
Credential:
Phone: 401-921-3320