MEDICARE: CROSSROADS HOME CARE SERVICES, LLC

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	251E00000X	Home Health Agency	1008390	IL
2	251E00000X	Home Health Agency	1011103	MO

General Provider Information

NPI Number	:	1437138070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSROADS HOME CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 51266
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70505-1266
Country	:	US
Telephone Number	:	337-233-1307
Fax Number	:	337-443-4154

Provider Business Practice Location Address
First Line	:	4112 N WATER TOWER PL STE A
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-6295
Country	:	US
Telephone Number	:	618-988-1840
Fax Number	:	618-988-8623

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSHUA L PROFFITT
Credential	:
Telephone Number	:	373-233-1307

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	07/08/2024

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