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General NPI Number Information
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NPI Number | 1316403405
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Entity Type | Organization
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Legal Business Name | CROSSROADS TREATMENT CENTERS OF TENNESSEE, PC
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Dates
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Enumeration Date | 02/14/2019
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Last Update Date | 07/01/2021
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Provider Practice Location Address
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Address Line | 2305 N GATEWAY AVE UNIT 4
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City | HARRIMAN
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State | TN
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Zip | 37748-8683
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Country | US
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Telephone | 800-805-6989
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Fax |
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Provider Business Mailing Address
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Address Line | 55 BEATTIE PL STE 810
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City | GREENVILLE
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State | SC
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Zip | 29601-2191
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Country | US
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Telephone | 800-805-6989
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | CREDENTIALING STAFF
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Credential |
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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 | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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