CROSSROADS TREATMENT CENTER OF LOUISVILLE PSC NPI 1649797507

NPI Information

NPI: 1649797507
Provider Name: CROSSROADS TREATMENT CENTER OF LOUISVILLE, PSC

Doing Business As: CROSSROADS TREATMENT CENTER OF LOUISVILLE

Classification: Clinic/Center - 261QM2800X
Entity Type: Organization

Specialization: Methadone

Address:
1700 CARGO CT
JEFFERSONTOWN, KY
ZIP 40299
Phone: (502) 749-6764
Get Directions

CROSSROADS TREATMENT CENTER OF LOUISVILLE, PSC is a methadone clinic center in Jeffersontown, KY. The provider is an entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. CROSSROADS TREATMENT CENTER OF LOUISVILLE, PSC NPI is 1649797507. The provider is registered as an organization entity type.
The provider Is Doing Business As Crossroads Treatment Center Of Louisville.

The provider's business location address is:

1700 CARGO CT
JEFFERSONTOWN, KY
ZIP 40299-938
Phone: (502) 749-6764
Fax: (502) 749-6843

The provider's authorized official is Rupert Mccormac .
The authorized official title is President and has the following contact phone number (800) 805-6989.

The CLIA number assigned to this NPI record is 18D2130877 - other - methadone clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/23/2017 and was last updated on 6/18/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	251S00000X	Community/Behavioral Health		No
2	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	No
3	261QM1300X	Clinic/Center	Multi-Specialty	No
4	261QP2300X	Clinic/Center	Primary Care	No
5	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	No
6	261QM2800X	Clinic/Center	Methadone	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	810552	OTHER	KENTUCKY	STATE LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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