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General NPI Number Information
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NPI Number | 1578938742
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Entity Type | Organization
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Legal Business Name | CROSSROADS BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 12/14/2015
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3107 SPRING GLEN RD SUITE 202
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City | JACKSONVILLE
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State | FL
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Zip | 32207-5916
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Country | US
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Telephone | 904-302-9929
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Fax |
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Provider Business Mailing Address
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Address Line | 3107 SPRING GLEN RD SUITE 202
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City | JACKSONVILLE
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State | FL
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Zip | 32207-5916
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Country | US
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Telephone | 904-302-9929
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. DARAL J WRIGHT
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Credential |
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Telephone | 904-302-9929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 1601
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License Number State | FL
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