MEDICARE: NATIONAL CROSSROADS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	276400000X	Substance Use Disorder Rehabilitation Hospital Unit
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
3	261QM2800X	Methadone Clinic

General Provider Information

NPI Number	:	1811858996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL CROSSROADS

Provider Business Mailing Address
First Line	:	4991 IMPERIAL AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92113-2063
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4990 HOLLY DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92113-2059
Country	:	US
Telephone Number	:	619-262-0868
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. LESLIE LAKE
Credential	:
Telephone Number	:	713-530-4728

Provider Enumeration Date	:	11/19/2025
Last Update Date	:	11/19/2025

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Directions to “NATIONAL CROSSROADS ” Practice Location

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