Basic Information
| Provider Information | |||||||||
| NPI: | 1871966424 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CROSSPOINT HUMAN SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 AVENUE C | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618325410 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 210 AVENUE C | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618325410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174423200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2015 | ||||||||
| LastUpdateDate: | 11/04/2015 | ||||||||
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| AuthorizedOfficialLastName: | POLLOCK | ||||||||
| AuthorizedOfficialFirstName: | THOM | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2174423200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | N | Agencies | Case Management | 320900000X | N | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 251C00000X | Y | Agencies | Day Training, Developmentally Disabled Services |
No ID Information.