1679248280 NPI number — CROSSROADS OF NEW JERSEY MANAGEMENT, LLC

Table of content: (NPI 1679248280)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679248280 NPI number — CROSSROADS OF NEW JERSEY MANAGEMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROSSROADS OF NEW JERSEY MANAGEMENT, LLC
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:
CROSSROADS TREATMENT CENTER OF NEPTUNE
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:
1679248280
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 E BROAD ST STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29601-2891
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-805-6989
Provider Business Mailing Address Fax Number:
864-558-8511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2040 6TH AVE STE C&D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEPTUNE CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07753-6101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-565-9747
Provider Business Practice Location Address Fax Number:
864-558-8511
Provider Enumeration Date:
08/16/2021

Additional Information

Authorized Official

Authorized Official Last Name:
MCCORMAC
Authorized Official First Name:
RUPERT
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
800-805-6989

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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