MEDICARE: CROSSROADS TREATMENT CENTERS

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	174400000X	Specialist	NC-10066-M	NC

General Provider Information

NPI Number	:	1366685364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSROADS TREATMENT CENTERS

Provider Business Mailing Address
First Line	:	436 SPRING GARDEN ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-2734
Country	:	US
Telephone Number	:	336-272-9990
Fax Number	:	336-574-8378

Provider Business Practice Location Address
First Line	:	436 SPRING GARDEN ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-2734
Country	:	US
Telephone Number	:	336-272-9990
Fax Number	:	336-574-8378

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	MR. ARTIE LIGHT
Credential	:	C.S.A.C., C.C.S.
Telephone Number	:	336-272-9990

Provider Enumeration Date	:	04/07/2009
Last Update Date	:	12/17/2009

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