Crossroads Treatment Centers of Tennessee, PC
Organization Active NPI Substance Use Disorder Rehabilitation Clinic/Center · Jacksboro, TN
NPI 1346850708 · NPPES record last updated Jul 1, 2021
Key facts
- NPI
- 1346850708
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
- Legal business name
- CROSSROADS TREATMENT CENTERS OF TENNESSEE, PC
- Practice address
- 114 Perkins LN
Jacksboro, TN 37757-2833 - Phone
- (864) 436-7266
- NPI assigned
- Jul 31, 2020
- Organization subpart
- No
Authorized official
- Name
- Rupert James McCormac
- Title
- President/Ceo
- Phone
- (800) 805-6989
Other NPIs on the same Medicare enrollment 13
Corporate family (same tax ID) 6
Practitioners 5
-
Carrie Ann Bailey, PHD, MSN, APRN-BC
-
Desiree Lynn Roa, M.D.
-
Amy Michelle Roberts, LCSW
-
Brittonya Sparks, FNP-BC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D2189623 | Crossroads Treatment Centers of Tennessee, PC | Certificate of waiver | Aug 3, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200213002831 | TN | Part B Supplier - Clinic/Group Practice | 6204262025 |
Receives reassigned benefits from 45 practitioners 13 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Tullahoma, TN; Sparta, TN; Oak Ridge, TN; Newport, TN; Morristown, TN; Johnson City, TN; Knoxville, TN; Jacksboro, TN… |
National Provider Directory
- Tax ID family
- Crossroads Treatment Centers of Tennessee PC
Locations
110 Raleigh Rd
Oak Ridge, TN 37830
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | Yes |
Addresses
Primary practice location
114 Perkins LN
Jacksboro, TN 37757-2833
Mailing address
55 Beattie PL Ste 810
Greenville, SC 29601-2191
Phone (864) 436-7266
Other providers in Jacksboro, TN
- Community Health of East Tennessee, Inc
- Compassionate Home Health Care LLC
- Compassionate Home Health Care, LLC
- Charley Crockett
- Felicia Adele Crockett
- Pamela G Davis
- Tonya L. Davis
- Subanithya Dhamotharan
- Riley K. Dunn
- Patricia Ann Eberharter
All providers in Jacksboro, TN · Substance Use Disorder Rehabilitation Clinic/Center in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 1, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.