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General NPI Number Information
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NPI Number | 1104085984
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Entity Type | Organization
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Legal Business Name | CROSSROADS TREATMENT CENTER, LLC
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Dates
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Enumeration Date | 06/05/2008
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 6 ROBERTS RD SUITE 103
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City | ASHEVILLE
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State | NC
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Zip | 28803-8613
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Country | US
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Telephone | 828-505-3086
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Fax |
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Provider Business Mailing Address
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Address Line | 6 ROBERTS RD SUITE 103
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City | ASHEVILLE
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State | NC
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Zip | 28803-8613
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Country | US
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Telephone | 828-505-3086
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RUPERT JAMES MCCORMAC IV
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Credential | M.D.
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Telephone | 864-270-6860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | RC03368490
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License Number State | NC
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