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General NPI Number Information
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NPI Number | 1376459800
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Entity Type | Organization
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Legal Business Name | CROSSROADS TREATMENT CENTER OF LOUISVILLE, PSC
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Dates
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Enumeration Date | 08/24/2026
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Last Update Date | 08/26/2026
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Provider Practice Location Address
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Address Line | 1700 CARGO CT
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City | JEFFERSONTOWN
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State | KY
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Zip | 40299-1938
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Country | US
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Telephone | 502-215-3938
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Fax |
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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 |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RUPERT MCCORMAC IV
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Credential |
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Telephone | 443-280-7071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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