Basic Information
| Provider Information | |||||||||
| NPI: | 1366064149 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CROSSROADS' TURNING POINTS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1530 W 17TH ST | ||||||||
| Address2: | |||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810031558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195443150 | ||||||||
| FaxNumber: | 7195834015 | ||||||||
| Practice Location | |||||||||
| Address1: | 2265 LAVA LN | ||||||||
| Address2: | |||||||||
| City: | ALAMOSA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 811013578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195895176 | ||||||||
| FaxNumber: | 7195895795 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2020 | ||||||||
| LastUpdateDate: | 05/14/2020 | ||||||||
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| AuthorizedOfficialLastName: | IRICK | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF CLINICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7195443150 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW,LAC | ||||||||
| NPICertificationDate: | 05/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
ID Information
| ID | Type | State | Issuer | Description | 11155051 | 05 | CO | MEDICAID |