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NPI Code Detail

MEDICARE: CROSSROADS TREATMENT CENTER OF ASHLAND, PSC

MEDICARE: CROSSROADS TREATMENT CENTER OF ASHLAND, PSC
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
1261QM1300XMulti-Specialty Clinic/Center
2261QM2800XMethadone ClinicKY
3251S00000XCommunity/Behavioral Health AgencyKY
4261QP2300XPrimary Care Clinic/Center
5261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
6261QR0405XSubstance Use Disorder Rehabilitation Clinic/CenterKY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1810586OTHERKYSTATE LICENSE

General Provider Information

NPI Number : 1346745718
Entity Type Code : Organization
Provider Name (Legal Business Name) : CROSSROADS TREATMENT CENTER OF ASHLAND, PSC
Provider Business Mailing Address
First Line : PO BOX 749057
Second Line :
City : ATLANTA
State : GA
Zip : 30374-9057
Country : US
Telephone Number : 800-805-6989
Fax Number : 864-558-8511
Provider Business Practice Location Address
First Line : 1220 GREENUP AVE
Second Line :
City : ASHLAND
State : KY
Zip : 41101-7525
Country : US
Telephone Number : 606-393-1165
Fax Number : 606-393-1775
Authorized Official
Title or Position : CEO
Name : RUPERT JAMES MCCORMAC IV
Credential :
Telephone Number : 800-805-6989
Provider Enumeration Date : 03/28/2018
Last Update Date : 06/06/2024

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