NPIMap

Organization Active NPI

Crossroads Treatment Center of Northern Kentucky, PSC

Doing business as Crossroads Treatment Center of Northern Kentucky; Crossroads Treatment

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Independence, KY
National Provider Identifier
1174040034
Registry record updated Nov 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
CROSSROADS TREATMENT CENTER OF NORTHERN KENTUCKY, PSC
Doing business as
Crossroads Treatment Center of Northern Kentucky; Crossroads Treatment
Practice address
1974 Walton Nicholson Pike
Independence, KY 41051-7906
Phone
(859) 359-5404
Fax
(859) 359-0739
NPI assigned
Aug 23, 2017
Last updated
Nov 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2024

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

Authorized official

Name
Rupert McCormac, MDNPI 1669486239
Title
Chief Executive Officer
Phone
(800) 805-6989

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Multi-Specialty Clinic/Center 261QM1300X NU
Methadone Clinic 261QM2800X NU
Primary Care Clinic/Center 261QP2300X NU
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU Primary
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

1974 Walton Nicholson Pike
Independence, KY 41051-7906

Mailing address

PO Box 749057
Atlanta, GA 30374-9057
Phone (800) 805-6989

Other identifiers 1

IdentifierTypeStateIssuer
810538OtherKYSTATE LICENSE

Other names 1

  • Crossroads Treatment Center of Northern Kentucky; Crossroads Treatment Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Opioid treatment program
Medicare-enrolled since Jan 1, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200108001227 KY Part B Supplier - Opioid Treatment Program (Otp) 6406281005 Practice locations: Independence, KY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D2126207Crossroads Treatment Center1974 Walton Nicholson Pike, Independence, KY 41051Certificate of waiverFeb 21, 2027

National Provider Directory

National Provider Directory

Locations

55 Beattie Pl
Ste 810
Greenville, SC 29601
Phone (864) 527-3145

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1503446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731024000000",
    "number": "1174040034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 749057",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303749057",
            "telephone_number": "800-805-6989",
            "fax_number": "864-558-8511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1974 WALTON NICHOLSON PIKE",
            "city": "INDEPENDENCE",
            "state": "KY",
            "postal_code": "410517906",
            "telephone_number": "859-359-5404",
            "fax_number": "859-359-0739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS TREATMENT CENTER OF NORTHERN KENTUCKY, PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-23",
        "last_updated": "2024-11-08",
        "certification_date": "2024-11-08",
        "status": "A",
        "authorized_official_last_name": "MCCORMAC",
        "authorized_official_first_name": "RUPERT",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "800-805-6989",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "810538",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crossroads Treatment Center of Northern Kentucky; Crossroads Treatment",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Independence, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.