MEDICARE: CROSSROADS BEHAVIORAL HEALTHCARE

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	APRN001898	NV

General Provider Information

NPI Number	:	1952798407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSROADS BEHAVIORAL HEALTHCARE

Provider Business Mailing Address
First Line	:	6069 S FORT APACHE RD
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5647
Country	:	US
Telephone Number	:	702-410-2631
Fax Number	:

Provider Business Practice Location Address
First Line	:	6069 S FORT APACHE RD
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5647
Country	:	US
Telephone Number	:	702-410-2631
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LEESHA BITTO
Credential	:	APRN,PMHNP
Telephone Number	:	702-763-6761

Provider Enumeration Date	:	04/22/2015
Last Update Date	:	04/22/2015

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