Basic Information
| Provider Information | |||||||||
| NPI: | 1316403405 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CROSSROADS TREATMENT CENTERS OF TENNESSEE, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 BEATTIE PL STE 810 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296012191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008056989 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2305 N GATEWAY AVE UNIT 4 | ||||||||
| Address2: | |||||||||
| City: | HARRIMAN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377488683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008056989 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2019 | ||||||||
| LastUpdateDate: | 07/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | STAFF | ||||||||
| AuthorizedOfficialFirstName: | CREDENTIALING | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8008056989 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | N | Ambulatory Health Care Facilities | Clinic/Center | Community Health | 261QM1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.