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General NPI Number Information
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NPI Number | 1912863465
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Entity Type | Organization
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Legal Business Name | CROSSROADS COMMUNITY HEALTH CLINIC, INC.
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Dates
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Enumeration Date | 12/29/2025
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 630 PASEO DEL PUEBLO SUR STE 140
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City | TAOS
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State | NM
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Zip | 87571-7002
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Country | US
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Telephone | 575-224-2110
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Fax |
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Provider Business Mailing Address
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Address Line | 630 PASEO DEL PUEBLO SUR STE 140
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City | TAOS
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State | NM
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Zip | 87571-7002
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Country | US
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Telephone | 575-224-2110
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Fax |
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Authorized Official
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Title or Position | RECOVERY COACH & PROGRAM LIAISON
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Name | MS. SHANA L JOHNSON
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Credential |
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Telephone | 575-224-2110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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