Crossroads Health

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

CROSSROADS HEALTH

Practice address

9220 Mentor Ave
Mentor, OH 44060-6412

Phone

(440) 354-9924

Fax

(877) 242-9583

NPI assigned

Feb 5, 2021

Last updated

Jan 29, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alice Iden

Title

Coo

Phone

(440) 255-1700

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Crossroads Lake County Adolescent Counseling Former legal business name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OH2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093307654. Details of each certification follow.

• CCN D21011 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN D21011

Legal name

CROSSROADS HEALTH

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Aug 10, 2023

Last certification

Aug 10, 2023

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Jul 1, 2019 in OH

Enrollment address

9220 Mentor Ave
Mentor, OH 44060-6412

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Crossroads Health

  • Adolescent and Children Mental Health Clinic/Center
  • Mentor, OH
  • NPI 1356303911

  9638440241

  Same PAC ID
• Crossroads Health

  • Community/Retail Pharmacy
  • Mentor, OH
  • NPI 1437733169

  9638440241

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Crossroads Health

  • Adolescent and Children Mental Health Clinic/Center
  • Mentor, OH
  • NPI 1356303911

  O20170731003569

  Same enrollment

Tax ID family

Crossroads Health Pharmacy5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

• Crossroads Health

  • Community/Behavioral Health Agency
  • Mentor, OH
  • NPI 1154680627
  NPD tax ID
• Crossroads Health

  • Community/Retail Pharmacy
  • Mentor, OH
  • NPI 1437733169
  NPD tax ID
• Crossroads Health

  • Addiction (Substance Use Disorder) Counselor
  • Mentor, OH
  • NPI 1518226075
  NPD tax ID
• Willow Glen

  • Professional Counselor
  • Cleveland, OH
  • NPI 1518843853
  NPD tax ID

Locations

All disclosed owners & managing parties 24

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Melissa D Cole, ARNP

  • Adult Health Nurse Practitioner
  • Tampa, FL
  • NPI 1437495397

  Corporate Director

  CMS ownership

Practitioners 42

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jaime Bishop, LSW, LPC, LPCC

  • Professional Counselor
  • Chagrin Falls, OH
  • NPI 1023178050
  NPD
• Suzanne L. Boehringer, LPCC-S

  • Mental Health Counselor
  • Beachwood, OH
  • NPI 1497127773
  NPD
• Claudia Patricia Cano, LPCC-S

  • Counselor
  • Mentor, OH
  • NPI 1417348863
  NPD
• Gabrielle Riana Christensen, LISW

  • Clinical Social Worker
  • Chardon, OH
  • NPI 1134623382
  NPD
• Dorit Cohen, MSW

  • Clinical Social Worker
  • Beachwood, OH
  • NPI 1841351335
  NPD
• Jamie Dials

  • Professional Counselor
  • Willoughby, OH
  • NPI 1528571528
  NPD
• Rebecca L Doman, LPCC-S, ATR-BC

  • Mental Health Counselor
  • Cleveland, OH
  • NPI 1598068447
  NPD
• Ashley Marie El-Khoury, LPCC

  • Mental Health Counselor
  • Mentor, OH
  • NPI 1558675256
  NPD
• Ebony Marie Elam, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Lyndhurst, OH
  • NPI 1568582724
  NPD
• Graesyn Layne Schwind Engler, LISW-S

  • Clinical Social Worker
  • Cleveland, OH
  • NPI 1962010256
  NPD
• Melissa Dawn Geiger-Dugandzic, LISW

  • Clinical Social Worker
  • Mentor, OH
  • NPI 1427513423
  NPD
• Susan E. Hoicowitz, LPC

  • Professional Counselor
  • Cleveland, OH
  • NPI 1710252523
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706486400000",
    "number": "1093307654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8445 MUNSON RD",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440602410",
            "telephone_number": "440-255-1700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9220 MENTOR AVE",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440606412",
            "telephone_number": "440-354-9924",
            "fax_number": "877-242-9583"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8445 Munson Rd",
            "address_purpose": "LOCATION",
            "city": "Mentor",
            "state": "OH",
            "postal_code": "440602410",
            "country_code": "US",
            "telephone_number": "440-255-1700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CROSSROADS HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-05",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-29",
        "status": "A",
        "authorized_official_last_name": "IDEN",
        "authorized_official_first_name": "ALICE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "440-255-1700"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0435072",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Carelogic",
            "affiliation": "N",
            "endpointDescription": "EMR",
            "address_1": "8445 Munson Rd",
            "city": "Mentor",
            "state": "OH",
            "country_code": "US",
            "postal_code": "440602410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Crossroads Lake County Adolescent Counseling",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Carlene Amelia Crislip, LPCC, ATR
• Jeffrey M Criss
• Javonna L Crook, LPC
• Telisa Cross, LPCC
• Crossroads
• Crossroads Health
• Crossroads Health
• Crossroads Health
• Crossroads Health
• Emily Ann Crtalic, OTR/L

• Federally Qualified Health Center (FQHC) in Mentor, OH
• Providers in Mentor, OH by specialty
• Federally Qualified Health Center (FQHC) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.