Provider Demographics
NPI:1053694802
Name:CROSSROADS BEHAVIORAL HEALTH CENTER
Entity type:Organization
Organization Name:CROSSROADS BEHAVIORAL HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECTUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:641-782-8457
Mailing Address - Street 1:1003 COTTONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801-1012
Mailing Address - Country:US
Mailing Address - Phone:641-782-8457
Mailing Address - Fax:641-782-7048
Practice Address - Street 1:1003 COTTONWOOD ST.
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801
Practice Address - Country:US
Practice Address - Phone:641-782-8457
Practice Address - Fax:641-782-7048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1317261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)