NPIMap

Organization Active NPI

Crossroads Wellness LLC

  • Substance Abuse Rehabilitation Facility
  • Baltimore, MD
National Provider Identifier
1811626559
Registry record updated Apr 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
CROSSROADS WELLNESS LLC
Practice address
1103 N Stricker St
Baltimore, MD 21217-2241
Phone
(410) 697-5502
Fax
(410) 457-9420
NPI assigned
Jun 8, 2022
Last updated
Apr 2, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
CROSSROADS WELLNESS LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 2, 2024

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

Authorized official

Name
Ms. Megan Joy Devaughn
Title
Partner
Phone
(443) 484-6408

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Adult Mental Health Clinic/Center 261QM0850X NU
Rehabilitation Clinic/Center 261QR0400X NU
Substance Abuse Rehabilitation Facility 324500000X NU Primary

Addresses

Primary practice location

1103 N Stricker St
Baltimore, MD 21217-2241

Mailing address

17331 Bushland Rd
Parkton, MD 21120-9476
Phone (443) 484-6408

Other practice location 1

1019 N Fulton Ave
Baltimore, MD 21217-1444
Phone (410) 697-5502

Other practice location 2

3302 Washington Blvd
Baltimore, MD 21227-1618
Phone (410) 697-5502

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL WWW.CROSSROADSWELLNESS.ORG
Other URL www.crossroadswellness.org Direct

National Provider Directory

National Provider Directory
Tax ID family
Crossroads Wellness LLC4 organizations share this tax ID, including this one
Part of
Crossroads Wellness LLC

Other organizations with this tax ID 3

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

Locations

3302 Washington Blvd
Baltimore, MD 21227
Phone (410) 697-5502

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1654646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712016000000",
    "number": "1811626559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17331 BUSHLAND RD",
            "city": "PARKTON",
            "state": "MD",
            "postal_code": "211209476",
            "telephone_number": "443-484-6408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 N STRICKER ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212172241",
            "telephone_number": "410-697-5502",
            "fax_number": "410-457-9420"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1019 N Fulton Ave",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212171444",
            "country_code": "US",
            "telephone_number": "410-697-5502",
            "fax_number": "410-457-9420",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3302 Washington Blvd",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212271618",
            "country_code": "US",
            "telephone_number": "410-697-5502",
            "fax_number": "410-457-9420",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CROSSROADS WELLNESS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CROSSROADS WELLNESS LLC",
        "enumeration_date": "2022-06-08",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A",
        "authorized_official_last_name": "DEVAUGHN",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_middle_name": "JOY",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "443-484-6408",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "WWW.CROSSROADSWELLNESS.ORG",
            "affiliation": "N",
            "address_1": "1103 N Stricker St",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212172241",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.crossroadswellness.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "website",
            "address_1": "3302 Washington Blvd",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212271618",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2024; 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.