Organization
CROSSROADS ISL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD MILLER (DIRECTOR)
(573) 472-9696
Entity
Organization
Contact information
Practice address
240 N KINGSHIGHWAY ST, SIKESTON, MO 63801-4102
(573) 472-9696
(573) 472-9494
Mailing address
240 N KINGSHIGHWAY ST, SIKESTON, MO 63801-4102
(573) 472-9696
(573) 472-9494
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
856107305
—
MO
Enumeration date
01/25/2007
Last updated
09/14/2009
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