Organization
CROSSROAD - FORT WAYNE CHILDRENS HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JC DOLLAR (CEO/PRESIDENT)
(260) 484-4153
Entity
Organization
Contact information
Practice address
2525 LAKE AVE, FORT WAYNE, IN 46805-5407
(260) 484-4153
Mailing address
2525 LAKE AVE, FORT WAYNE, IN 46805-5407
(260) 484-4153
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
7342602900837
IN
Other
Enumeration date
10/18/2006
Last updated
08/22/2020
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