NPIMap

Organization Active NPI

Crossroads Health

  • Community/Retail Pharmacy
  • Mentor, OH
National Provider Identifier
1437733169
Registry record updated Jul 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
CROSSROADS HEALTH
Practice address
9220 Mentor Ave Ste a
Mentor, OH 44060-6412
Phone
(440) 255-1700
NPI assigned
May 10, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2021

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

9220 Mentor Ave Ste a
Mentor, OH 44060-6412

Mailing address

8445 Munson Rd
Mentor, OH 44060-2410
Phone (440) 255-1700

Other names 1

  • Crossroads Lake County Adolescent Counseling Services Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211202001768 OH Part B Supplier - Pharmacy 9638440241 Practice locations: Mentor, OH

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
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.

Locations

9220 Mentor Ave
Ste A
Mentor, OH 44060
Phone (440) 856-0190

NPI Registry JSON

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

{
    "created_epoch": "1620604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626912000000",
    "number": "1437733169",
    "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 STE A",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440606412",
            "telephone_number": "440-255-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-10",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "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": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crossroads Lake County Adolescent Counseling Services",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Crossroads Lake County Adolescent Counseling Services",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Mentor, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.