# CROSSROADS HEALTH & COSMETIC CENTER PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700259173
- **Authorized official:** JOANNA ROTH ACNP-BC, FNP-C (NURSE PRACTITIONER)
- **Authorized official phone:** (574) 891-4920

## Contact information

- **Practice address:** 21764 OMEGA CT, GOSHEN, IN 46528-7809
- **Practice address phone:** (574) 891-4920
- **Practice address fax:** (574) 891-4902
- **Mailing address:** 21764 OMEGA CT, GOSHEN, IN 46528-7809
- **Mailing address phone:** (574) 891-4920
- **Mailing address fax:** (574) 891-4902

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 71002933A | IN | Yes |
| 363LA2100X | Acute Care Nurse Practitioner | 71002933A | IN | — |
| 363LP2300X | Primary Care Nurse Practitioner | 71002933A | IN | — |

## Other

- **Enumeration date:** 11/07/2015
- **Last updated:** 09/09/2019