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General NPI Number Information
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NPI Number | 1275930406
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Entity Type | Organization
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Legal Business Name | CROSSROADS HOME HEALTH, INC.
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 12/03/2014
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Provider Practice Location Address
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Address Line | 3600 E STATE ST SUITE 201
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City | ROCKFORD
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State | IL
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Zip | 61108-1978
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Country | US
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Telephone | 815-977-3452
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Fax | 815-977-8162
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Provider Business Mailing Address
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Address Line | 3600 E STATE ST SUITE 201
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City | ROCKFORD
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State | IL
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Zip | 61108-1978
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Country | US
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Telephone | 815-977-3452
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Fax | 815-977-8162
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARK HARLING
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Credential |
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Telephone | 815-977-3452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 3000983
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License Number State | IL
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