Organization
CROSSROADS TREATMENT CENTER OF LAGRANGE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUPERT JAMES MCCORMAC MD (PRESIDENT)
(800) 805-6989
Entity
Organization
Contact information
Practice address
229 S DAVIS RD, SUITE 900, LAGRANGE, GA 30241-2608
(008) 056-9898
(864) 558-8511
Mailing address
PO BOX 749057, ATLANTA, GA 30374-9057
(800) 805-6989
(864) 558-8511
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QM2800X
Methadone Clinic
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NTP001092
STATE LICENSE
GA
Enumeration date
02/10/2017
Last updated
02/06/2024
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