| Crossroads Treatment Centers Tyler | |
|
1510 S Vine Ave Tyler TX 75701-2826 | |
| (800) 805-6989 | |
| Not Available |
| Full Name | Crossroads Treatment Centers Tyler |
|---|---|
| Speciality | Clinic/Center |
| Location | 1510 S Vine Ave, Tyler, Texas |
| Authorized Official Name and Position | Rupert Mccormac (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8008056898 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Crossroads Treatment Centers Tyler Po Box 749057 Atlanta GA 30374-9057 Ph: (800) 805-6989 | Crossroads Treatment Centers Tyler 1510 S Vine Ave Tyler TX 75701-2826 Ph: (800) 805-6989 |
| NPI Number | 1104144088 |
|---|---|
| Provider Enumeration Date | 05/17/2010 |
| Last Update Date | 09/03/2024 |
| Certification Date | 09/03/2024 |
| Medicare PECOS PAC ID | 4981039179 |
|---|---|
| Medicare Enrollment ID | O20200116000722 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104144088 | NPI | - | NPPES |
| 2121550 | Medicaid | TX |
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