Provider Demographics
NPI:1316062862
Name:SOUTHERN CROSS COMMUNITY SERVICES, INC
Entity type:Organization
Organization Name:SOUTHERN CROSS COMMUNITY SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:843-716-6000
Mailing Address - Street 1:PO BOX 656
Mailing Address - Street 2:
Mailing Address - City:TABOR CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28463-0656
Mailing Address - Country:US
Mailing Address - Phone:843-716-6000
Mailing Address - Fax:843-716-6007
Practice Address - Street 1:2202 WRIGHTSVILLE AVENUE
Practice Address - Street 2:SUITE 114
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2406
Practice Address - Country:US
Practice Address - Phone:910-763-3773
Practice Address - Fax:910-763-3799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 251K00000X
NC3756251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301907Medicaid
NC8301907BMedicaid
NC8301907GMedicaid