Organization
CROSSROADS FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DORA MARIA COSTELLO (EXECUTIVE DIRECTOR)
(619) 296-1151
Entity
Organization
Contact information
Practice address
3594 4TH AVE, SAN DIEGO, CA 92103-4940
(619) 296-1151
(619) 255-6407
Mailing address
3594 4TH AVE, SAN DIEGO, CA 92103-4940
(619) 296-1151
(619) 255-6407
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
370002AN
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37-0001
STATE PROVIDER CODE
CA
Enumeration date
04/16/2007
Last updated
08/22/2020
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