Provider Demographics
NPI:1053475947
Name:ROGERS DEVELOPMENT GROUP
Entity Type:Organization
Organization Name:ROGERS DEVELOPMENT GROUP
Other - Org Name:CROSS CREEK GROUP HOMES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:ROGERS
Authorized Official - Last Name:MCRAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-277-9280
Mailing Address - Street 1:PO BOX 2250
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28353-2250
Mailing Address - Country:US
Mailing Address - Phone:910-277-9281
Mailing Address - Fax:910-277-9278
Practice Address - Street 1:321 WILSON ST
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-4533
Practice Address - Country:US
Practice Address - Phone:910-277-9281
Practice Address - Fax:910-277-9278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-083-019320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603026Medicaid