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NPI Code Detail

MEDICARE: CROSSROADS TREATMENT CENTER OF FORT WORTH, PLLC

MEDICARE: CROSSROADS TREATMENT CENTER OF FORT WORTH, PLLC
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
1251S00000XCommunity/Behavioral Health Agency
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
3261QM1300XMulti-Specialty Clinic/Center
4261QP2300XPrimary Care Clinic/Center
5261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
6261QM2800XMethadone Clinic

General Provider Information

NPI Number : 1245765585
Entity Type Code : Organization
Provider Name (Legal Business Name) : CROSSROADS TREATMENT CENTER OF FORT WORTH, PLLC
Provider Business Mailing Address
First Line : 200 E BROAD ST STE 300
Second Line :
City : GREENVILLE
State : SC
Zip : 29601-2891
Country : US
Telephone Number : 800-805-6989
Fax Number : 864-558-8511
Provider Business Practice Location Address
First Line : 6733 CAMP BOWIE BLVD
Second Line :
City : FORT WORTH
State : TX
Zip : 76116-7112
Country : US
Telephone Number : 817-386-9180
Fax Number :
Authorized Official
Title or Position : OPERATIONS SPECIALIST FOR STRATEGIC
Name : MEGAN THOMAS
Credential :
Telephone Number : 800-805-6989
Provider Enumeration Date : 04/24/2017
Last Update Date : 06/18/2022

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