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General NPI Number Information
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NPI Number | 1174725808
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Entity Type | Organization
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Legal Business Name | CROSSROADS RESCUE MISSION
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 944 S ARIZONA AVE
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City | YUMA
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State | AZ
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Zip | 85364-3947
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Country | US
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Telephone | 928-783-9362
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Fax | 928-783-5457
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Provider Business Mailing Address
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Address Line | 944 S ARIZONA AVE
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City | YUMA
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State | AZ
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Zip | 85364-3947
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Country | US
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Telephone | 928-783-9362
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Fax | 928-783-5457
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. MYRA GARLIT
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Credential | M. ED., LISAC
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Telephone | 928-726-0491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | BH 1142
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License Number State | AZ
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