CROSSROADS LIVING CENTER, INC. (NPI# 1083882658) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083882658 |
| Entity Type | Organization |
| Organization Name | CROSSROADS LIVING CENTER, INC. |
| Practice Address |
325 Honeysuckle Dr Fairfield CA 94533-1124 |
| Mailing Address |
320 Cernon St Vacaville CA 95688-4502 |
| Practice Telephone | 7074499377 |
| Mailing Telephone | 7074499377 |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2008-02-19 |
| Authorized Official Name | SARA JANE DUTRA (BOOKKEEPER) |
| Authorized Official Telephone | 5305327889 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | CA | Nursing & Custodial Care Facilities |
| Street Address |
325 HONEYSUCKLE DR |
| City | FAIRFIELD |
| State | CA |
| Zip Code | 94533-1124 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609487347 | Shayondelice Sledge | Case Manager/Care Coordinator | 3001 N. Texas St., #27, Fairfield, CA 94533 | 2020-08-16 |
| 1508401191 | Tiffany Ann Garcia | Social Worker | 1301 Roman Way, Martinez, CA 94533 | 2019-11-07 |
| 1609424175 | Andrew Stephens | Student in an Organized Health Care Education/Training Program | Dgmc, 101 Bodin Cir, Fairfield, CA 94533 | 2019-08-28 |
| 1821645383 | Michelle Marie Hackett | Marriage & Family Therapist | 1745 Enterprise Dr., Bldg. 2, Ste 1a, Fairfield, CA 94533 | 2019-08-20 |
| 1780154369 | Maria Leonila Ramos Corpuz | Behavior Technician | 744 Empire Street Suite 160, Fairfield, CA 94533 | 2018-11-27 |
| 1629575303 | Jeanne Ann Kiernan | Dentist | 690 Airman Dr, Apo, AA 94533 | 2018-04-10 |
| 1629596820 | Max Kardos | Student in an Organized Health Care Education/Training Program | 801 Empire St., Fairfield, CA 94533 | 2017-09-07 |
| 1780119867 | Justin Denhart Dickson | Student in an Organized Health Care Education/Training Program | 101 Bodin Cir Fairfield Ca 94533, David Grant Medical Center, Fpo, AA 94533 | 2017-04-26 |
| 1639613409 | Behrooz Shafiezadeh | Marriage & Family Therapist | Caminar, 601 Madison Street, Suite D, Fairfield, CA 94533 | 2016-12-13 |
| 1427500164 | Tanya Ayers | Counselor | 801 Empire Street, Fairfield, CA 94533 | 2016-10-28 |
| Find all providers in zip 94533 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
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| 1164888160 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 1406 W Delaware St, Fairfield, IL 62837-2336 | 2016-01-06 |
| 1790141794 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 867 County Road 2150 E, Fairfield, IL 62837-2824 | 2016-01-06 |
| 1023206380 | Rescare Ohio, Inc. | Intermediate Care Facility, Mentally Retarded | 5099 Camelot Dr, Fairfield, OH 45014-7423 | 2007-10-11 |
| 1841342771 | Developmental Planning & Services Inc | Intermediate Care Facility, Mentally Retarded | Rr 3 Box 601, Fairfield, IL 62837-9565 | 2007-01-18 |
| 1821158981 | North Country Associates, Inc | Intermediate Care Facility, Mentally Retarded | 149 Route 201, Fairfield, ME 04937-3372 | 2006-12-11 |
| 1972670016 | Miller Holdings Takoda, Inc. | Intermediate Care Facility, Mentally Retarded | 350 Kolb Dr, Fairfield, OH 45014-5357 | 2006-11-30 |
| 1245303528 | Jjr Enterprises Inc | Intermediate Care Facility, Mentally Retarded | 813 W Center St, Fairfield, IL 62837-1403 | 2006-11-16 |
| 1356707350 | T | Intermediate Care Facility, Mentally Retarded | 813 W Center St, Fairfield, IL 62837-1403 | 2016-01-06 |
| 1033474051 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 813 W Center St, Fairfield, IL 62837-1403 | 2012-07-05 |
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| 1124661699 | Rscr California, Inc. | Intermediate Care Facility, Mentally Retarded | 581 S Gilmar St, Anaheim, CA 92802-1306 | 2019-10-28 |
| 1467095935 | Rscr California, Inc. | Intermediate Care Facility, Mentally Retarded | 1592 W Lorane Way, Anaheim, CA 92802-3930 | 2019-10-28 |
| 1992348460 | Rscr California, Inc. | Intermediate Care Facility, Mentally Retarded | 5940 Los Angeles Way, Buena Park, CA 90620-2723 | 2019-10-28 |
| 1578106043 | Rscr California, Inc. | Intermediate Care Facility, Mentally Retarded | 2918 E Greenhedge Ave, Anaheim, CA 92806-3804 | 2019-10-28 |
| 1790328680 | Rscr California, Inc. | Intermediate Care Facility, Mentally Retarded | 2143 W Fir Ave, Anaheim, CA 92801-3436 | 2019-10-23 |
| 1356984249 | Rscr California, Inc. | Intermediate Care Facility, Mentally Retarded | 6540 Christine Cir, Buena Park, CA 90620-4511 | 2019-10-23 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.