Basic Information
Provider Information | |||||||||
NPI: | 1265713820 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CROSSPOINT HUMAN SERVICES | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 210 AVENUE C | ||||||||
Address2: |   | ||||||||
City: | DANVILLE | ||||||||
State: | IL | ||||||||
PostalCode: | 618325410 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2174423200 | ||||||||
FaxNumber: | 2174427460 | ||||||||
Practice Location | |||||||||
Address1: | 201 N HAZEL ST | ||||||||
Address2: |   | ||||||||
City: | DANVILLE | ||||||||
State: | IL | ||||||||
PostalCode: | 618324723 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2174461217 | ||||||||
FaxNumber: | 2174436845 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/08/2011 | ||||||||
LastUpdateDate: | 02/02/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | RHODES | ||||||||
AuthorizedOfficialFirstName: | LISA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 2174423200 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/02/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 252Y00000X |   |   | Y |   | Agencies | Early Intervention Provider Agency |   |
No ID Information.