=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346407467
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOUSE OF THE CROSSROADS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2008
-----------------------------------------------------
Last Update Date | 05/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2012 CENTRE AVE
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15219-6302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-281-5080
-----------------------------------------------------
Fax | 412-281-4397
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2012 CENTRE AVE
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15219-6302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-281-5080
-----------------------------------------------------
Fax | 412-281-4397
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. LAWRENCE JOSEPH DEMARZO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 412-281-5265
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | 740096
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------