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General NPI Number Information
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NPI Number | 1174040034
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Entity Type | Organization
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Legal Business Name | CROSSROADS TREATMENT CENTER OF NORTHERN KENTUCKY, PSC
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Dates
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Enumeration Date | 08/23/2017
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 1974 WALTON NICHOLSON PIKE
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City | INDEPENDENCE
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State | KY
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Zip | 41051-7906
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Country | US
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Telephone | 859-359-5404
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Fax | 859-359-0739
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Provider Business Mailing Address
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Address Line | PO BOX 749057
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City | ATLANTA
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State | GA
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Zip | 30374-9057
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Country | US
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Telephone | 800-805-6989
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Fax | 864-558-8511
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | RUPERT MCCORMAC
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Credential | MD
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Telephone | 800-805-6989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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Taxonomy #4
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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Taxonomy #5
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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Taxonomy #6
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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