MEDICARE: CROSSROADS CENTER FOR RECOVERY

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1740600410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSROADS CENTER FOR RECOVERY

Provider Business Mailing Address
First Line	:	1001 MULHOLLAND ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-7646
Country	:	US
Telephone Number	:	989-391-9900
Fax Number	:	989-497-1530

Provider Business Practice Location Address
First Line	:	1001 MULHOLLAND ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-7646
Country	:	US
Telephone Number	:	989-391-9900
Fax Number	:	989-497-1530

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	KATHY PALMER
Credential	:	LMSW
Telephone Number	:	989-391-9900

Provider Enumeration Date	:	04/22/2014
Last Update Date	:	04/22/2014

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Directions to “CROSSROADS CENTER FOR RECOVERY ” Practice Location

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