Organization
CROSSROADS REHABILITATION SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN A PARK OTR/L, CHT (VICE-PRESIDENT)
(662) 534-4445
Entity
Organization
Contact information
Practice address
206B OXFORD RD, NEW ALBANY, MS 38652-3115
(662) 534-4445
(662) 534-9449
Mailing address
206B OXFORD RD, NEW ALBANY, MS 38652-3115
(662) 534-4445
(662) 534-9449
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
09198/11.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01874080
—
MS
Enumeration date
02/03/2012
Last updated
02/03/2012
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