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General NPI Number Information
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NPI Number | 1912061508
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Entity Type | Organization
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Legal Business Name | CROSSROADS RESCUE MISSION
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 08/09/2013
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Provider Practice Location Address
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Address Line | 944 S ARIZONA AVE
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City | YUMA
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State | AZ
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Zip | 85364-3947
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Country | US
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Telephone | 928-783-9362
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Fax | 928-329-6020
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Provider Business Mailing Address
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Address Line | P.O. BOX 1161
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City | YUMA
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State | AZ
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Zip | 85366
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Country | US
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Telephone | 928-726-0491
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Fax | 928-314-0717
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. MYRA E. GARLIT
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Credential | LISAC
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Telephone | 928-783-9362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | BH-1142
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License Number State | AZ
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