MEDICARE: CROSSPOINTE MENTAL HEALTH, 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	251C00000X	Developmentally Disabled Services Day Training Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811389299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSPOINTE MENTAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	1415 FILLMORE STREET
Second Line	:	SUITE 702 AND 703
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-3392
Country	:	US
Telephone Number	:	208-736-7090
Fax Number	:	208-736-7089

Provider Business Practice Location Address
First Line	:	1415 FILLMORE ST
Second Line	:	SUITE 702 & 703
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-3399
Country	:	US
Telephone Number	:	208-736-7090
Fax Number	:	208-736-7089

Authorized Official
Title or Position	:	OWNER
Name	:	NYLA M JENSEN
Credential	:
Telephone Number	:	208-736-7090

Provider Enumeration Date	:	02/23/2015
Last Update Date	:	06/30/2015

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