Crossroads Isl, LLC
Organization Active NPI Developmentally Disabled Services Day Training Agency · Sikeston, MO
NPI 1427102482 · NPPES record last updated Sep 14, 2009
Key facts
- NPI
- 1427102482
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Developmentally Disabled Services Day Training Agency 251C00000X
- License
- 6008-8221 (MO)
- Legal business name
- CROSSROADS ISL, LLC
- Practice address
- 240 N Kingshighway St
Sikeston, MO 63801-4102 - Phone
- (573) 472-9696
- Fax
- (573) 472-9494
- NPI assigned
- Jan 23, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Edward Miller
- Title
- Director
- Phone
- (573) 472-9696
Corporate family (same tax ID) 2
National Provider Directory
- Tax ID family
- Crossroads Isl LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmentally Disabled Services Day Training Agency | 251C00000X | 6008-8221 | MO | Yes |
Addresses
Primary practice location
240 N Kingshighway St
Sikeston, MO 63801-4102
Mailing address
240 N Kingshighway St
Sikeston, MO 63801-4102
Phone (573) 472-9696
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 856107305 | Medicaid | MO | |
| 266107309 | Medicaid | MO | |
| 286107305 | Medicaid | MO |
Other providers in Sikeston, MO
- Kylie Suzanne Crader
- Crain Moxey Pharm Inc
- Karen Crane
- Christopher Creecy
- Michael Edward Critchlow
- Crossroads Isl, LLC
- Crossroads Isl, LLC
- Sarah H Curry
- David Dahlbeck
- Ryan Jon Dalisky
All providers in Sikeston, MO · Developmentally Disabled Services Day Training Agency in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 14, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.