Provider Demographics
NPI:1619307634
Name:CROSSROAD MANAGEMENT LLC
Entity type:Organization
Organization Name:CROSSROAD MANAGEMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:LAGRONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-592-3416
Mailing Address - Street 1:125 S ZACK HINTON PKWY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3335
Mailing Address - Country:US
Mailing Address - Phone:678-592-3416
Mailing Address - Fax:
Practice Address - Street 1:125 S ZACK HINTON PKWY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3335
Practice Address - Country:US
Practice Address - Phone:678-592-3416
Practice Address - Fax:678-583-3081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management