NPIMap

Organization Active NPI

Crossroad Child & Family Services, Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Fort Wayne, IN
National Provider Identifier
1699868893
Registry record updated Feb 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
3001702900002 Issued in IN
Legal business name
CROSSROAD CHILD & FAMILY SERVICES, INC.
Practice address
1825 Beacon Street
Fort Wayne, IN 46805
Phone
(260) 484-4153
Fax
(260) 484-2337
NPI assigned
Oct 2, 2006
Last updated
Feb 14, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2024

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

Authorized official

Name
David Mullins
Title
President/Ceo
Phone
(260) 484-4153

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 3001702900002 IN Primary
Psychiatric Residential Treatment Facility 323P00000X 3001702900002 IN

Addresses

Primary practice location

1825 Beacon Street
Fort Wayne, IN 46805

Mailing address

1825 Beacon Street
Fort Wayne, IN 46805
Phone (260) 484-4153

Other identifiers 1

IdentifierTypeStateIssuer
200295210MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699868893. Details of each certification follow.

  • CCN 15L002 Psychiatric residential treatment facility · Active · Name & address match · Details

Psychiatric residential treatment facility certification: CCN 15L002

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CROSSROAD CHILD & FAMILY SERVICES INC
Certification status
Active
Provider type (POS)
Psychiatric residential treatment facility
Participating since
Apr 19, 2004
Last certification
Nov 15, 2023
Beds
30
Ownership / control type
Non-profit – other
Facility address
1825 Beacon Street
Fort Wayne, IN 46805

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
15D2026190Crossroad Child and Family Services1825 Beacon Street, Fort Wayne, IN 46805Certificate of waiverJun 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Crossroad Child and Family Services3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2525 Lake Ave
Fort Wayne, IN 46805
Phone (260) 484-4153

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707868800000",
    "number": "1699868893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1825 BEACON STREET",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46805",
            "telephone_number": "260-484-4153",
            "fax_number": "260-484-2337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 BEACON STREET",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46805",
            "telephone_number": "260-484-4153",
            "fax_number": "260-484-2337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROAD CHILD & FAMILY SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2024-02-14",
        "status": "A",
        "authorized_official_last_name": "MULLINS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "260-484-4153"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "IN",
            "license": "3001702900002",
            "primary": true
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "IN",
            "license": "3001702900002",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200295210",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.