1164884144 NPI number — CROSSROADS' TURNING POINTS, INC.

Table of content: (NPI 1164884144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164884144 NPI number — CROSSROADS' TURNING POINTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROSSROADS' TURNING POINTS, 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:
Provider Other Organization Name Type Code:
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:
1164884144
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/22/2020
NPI Reactivation Date:
05/24/2021

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 MONTEBELLO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUEBLO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81001-1237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-546-6667
Provider Business Mailing Address Fax Number:
719-546-8273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
739 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTE VISTA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81144-1462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-852-3955
Provider Business Practice Location Address Fax Number:
719-589-5795
Provider Enumeration Date:
03/28/2016

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
BANAFSHE'
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING & ENROLLMENT SPEC
Authorized Official Telephone Number:
719-419-7959

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 57155038 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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