1063611572 NPI number — CROSSROADS HOSPICE, INC.

Table of content: (NPI 1063611572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063611572 NPI number — CROSSROADS HOSPICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROSSROADS HOSPICE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE CARE TEAM HOSPICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063611572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30600 NORTHWESTERN HWY STE 245
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48334-3171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-957-1999
Provider Business Mailing Address Fax Number:
888-990-0589

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8582 KATY FWY STE 225
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-791-6770
Provider Business Practice Location Address Fax Number:
832-280-6776
Provider Enumeration Date:
07/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DEWBRE
Authorized Official First Name:
VALERIE
Authorized Official Middle Name:
JO
Authorized Official Title or Position:
CHIEF COMPLIANCE OFFICER
Authorized Official Telephone Number:
214-534-0716

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)