| NPI | 1437733169 |
|---|---|
| Former Legal Business Name | CROSSROADS LAKE COUNTY ADOLESCENT COUNSELING SERVICES |
| Entity Type | Organization |
| Authorized Contact | ALICE IDEN COO 440-255-1700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2021-05-10 |
| Last Update Date | 2021-07-22 |