1225194004 NPI number — CROSS ROADS RECONCILIATION SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225194004 NPI number — CROSS ROADS RECONCILIATION SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROSS ROADS RECONCILIATION SERVICES
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:
CROSS ROADS CHRISTIAN COUNSELING CENTER
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:
1225194004
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 PINEY FOREST RD
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24540-2867
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-791-2767
Provider Business Mailing Address Fax Number:
434-791-4944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 PINEY FOREST RD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24540-2867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-791-2767
Provider Business Practice Location Address Fax Number:
434-791-4944
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CURTIS
Authorized Official First Name:
REGINA
Authorized Official Middle Name:
DAVIS
Authorized Official Title or Position:
CLINICAL SUPERVISOR
Authorized Official Telephone Number:
434-791-2767

Provider Taxonomy Codes

  • Taxonomy code: 101YP1600X , with the licence number:  CU74420 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com