| Crossroads Behavioral Health, Inc. | |
|
91-1010 Shangrila St Ste 105 Kapolei HI 96707-2176 | |
| (808) 377-4300 | |
| Not Available |
| Full Name | Crossroads Behavioral Health, Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 91-1010 Shangrila St Ste 105, Kapolei, Hawaii |
| Authorized Official Name and Position | Robert E Jackson (PRESIDENT) |
| Authorized Official Contact | 8082943493 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Crossroads Behavioral Health, Inc. Po Box 701089 Kapolei HI 96709-1089 Ph: (808) 294-3493 | Crossroads Behavioral Health, Inc. 91-1010 Shangrila St Ste 105 Kapolei HI 96707-2176 Ph: (808) 377-4300 |
| NPI Number | 1013414770 |
|---|---|
| Provider Enumeration Date | 04/10/2018 |
| Last Update Date | 03/13/2019 |
| Medicare PECOS PAC ID | 5092040048 |
|---|---|
| Medicare Enrollment ID | O20190712000402 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013414770 | NPI | - | NPPES |
| Provider Name | Robert Eric Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1245219849 PECOS PAC ID: 7416196035 Enrollment ID: I20130611000834 |
| Provider Name | Janna Marie Madeira |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1194039230 PECOS PAC ID: 6507005501 Enrollment ID: I20130624000690 |
| Provider Name | Andrew Loran Gold |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1972903136 PECOS PAC ID: 9638491871 Enrollment ID: I20180212001418 |
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