MEDICARE: CROSSROADS WEST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility	BH-2209	AZ
2	324500000X	Substance Abuse Rehabilitation Facility	BH-2209	AZ

General Provider Information

NPI Number	:	1003244153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSROADS WEST

Provider Business Mailing Address
First Line	:	2002 E OSBORN RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7236
Country	:	US
Telephone Number	:	602-263-5242
Fax Number	:

Provider Business Practice Location Address
First Line	:	7523 N 35TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-7422
Country	:	US
Telephone Number	:	602-249-8002
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CHRIS RILEY
Credential	:
Telephone Number	:	602-263-5242

Provider Enumeration Date	:	10/29/2013
Last Update Date	:	06/05/2025

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Practice Location Address:

7523 N 35TH AVE
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1083967376 — FSL PATHWAYS
Practice Location Address:

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Directions to “CROSSROADS WEST ” Practice Location

Language	Start Address	Practice Location

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