NPIMap

Organization Active NPI

Crossroads Foundation

  • Substance Abuse Rehabilitation Facility
  • San Diego, CA
National Provider Identifier
1881819621
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
370002AN Issued in CA
Legal business name
CROSSROADS FOUNDATION
Practice address
3594 4TH Ave
San Diego, CA 92103-4940
Phone
(619) 296-1151
Fax
(619) 255-6407
NPI assigned
Apr 16, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Dora Maria Costello
Title
Executive Director
Phone
(619) 296-1151

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 370002AN CA Primary

Addresses

Primary practice location

3594 4TH Ave
San Diego, CA 92103-4940

Mailing address

3594 4TH Ave
San Diego, CA 92103-4940
Phone (619) 296-1151

Other identifiers 1

IdentifierTypeStateIssuer
37-0001OtherCASTATE PROVIDER CODE

National Provider Directory

National Provider Directory

Locations

3594 4th Ave
San Diego, CA 92103
Phone (619) 296-1151

Practitioners & affiliated clinicians

Practitioners 37

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 37

NPI Registry JSON

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881819621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3594 4TH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921034940",
            "telephone_number": "619-296-1151",
            "fax_number": "619-255-6407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3594 4TH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921034940",
            "telephone_number": "619-296-1151",
            "fax_number": "619-255-6407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COSTELLO",
        "authorized_official_first_name": "DORA",
        "authorized_official_middle_name": "MARIA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "619-296-1151",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "370002AN",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE PROVIDER CODE",
            "identifier": "37-0001",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.