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General NPI Number Information
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NPI Number | 1821143025
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Entity Type | Organization
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Legal Business Name | CROSSROADS ISL, LLC
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 09/14/2009
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Provider Practice Location Address
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Address Line | 240 N KINGSHIGHWAY ST
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City | SIKESTON
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State | MO
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Zip | 63801-4102
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Country | US
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Telephone | 573-472-9696
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Fax | 573-472-9494
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Provider Business Mailing Address
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Address Line | 240 N KINGSHIGHWAY ST
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City | SIKESTON
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State | MO
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Zip | 63801-4102
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Country | US
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Telephone | 573-472-9696
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Fax | 573-472-9494
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. EDWARD MILLER
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Credential |
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Telephone | 573-472-9696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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