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General NPI Number Information
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NPI Number | 1699868893
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Entity Type | Organization
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Legal Business Name | CROSSROAD CHILD & FAMILY SERVICES, INC.
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 1825 BEACON STREET
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City | FORT WAYNE
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State | IN
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Zip | 46805
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Country | US
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Telephone | 260-484-4153
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Fax | 260-484-2337
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Provider Business Mailing Address
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Address Line | 1825 BEACON STREET
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City | FORT WAYNE
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State | IN
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Zip | 46805
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Country | US
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Telephone | 260-484-4153
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Fax | 260-484-2337
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DAVID MULLINS
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Credential |
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Telephone | 260-484-4153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | 3001702900002
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 3001702900002
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License Number State | IN
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