Crossroads Health Idaho LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

CROSSROADS HEALTH IDAHO LLC

Practice address

8950 W Emerald St Ste 178
Boise, ID 83704-8296

Phone

(208) 376-7083

NPI assigned

Oct 10, 2019

Organization subpart

Yes

Parent organization

CROSSROADS OF WESTERN IOWAAs reported in NPPES

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

Authorized official

Name

Darian Zima

Title

Cfo

Phone

(712) 256-7888

Specialties & licenses 2

Addresses

Part of

Trivium Life Services

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

{
    "created_epoch": "1570665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570665600000",
    "number": "1326680422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1851 MADISON AVE STE 718",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515033602",
            "telephone_number": "712-256-7888",
            "fax_number": "712-256-6502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8950 W EMERALD ST STE 178",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048296",
            "telephone_number": "208-376-7083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS HEALTH IDAHO LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CROSSROADS OF WESTERN IOWA",
        "enumeration_date": "2019-10-10",
        "last_updated": "2019-10-10",
        "status": "A",
        "authorized_official_last_name": "ZIMA",
        "authorized_official_first_name": "DARIAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "712-256-7888"
    },
    "taxonomies": [
        {
            "code": "103TP2701X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Group Psychotherapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cross Natural Health
• Leticia Cross, LCSW
• Sunday Beth Cross, LMSW
• Jacob Crossley, PHARMD
• Crossover Health Medical Group
• James Alden Crouch, MD
• Miranda J Crouch, MD
• Jennifer M. Crouder, LCPC
• Erin Crow, PT
• Jenny Crow, LMSW, RPT

• Substance Use Disorder Rehabilitation Clinic/Center in Boise, ID
• Providers in Boise, ID by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.