Provider Demographics
NPI:1346307238
Name:CROSS ROAD YOUTH SERVICES II, INC.
Entity Type:Organization
Organization Name:CROSS ROAD YOUTH SERVICES II, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALIFIED PROFESSIONAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:W
Authorized Official - Last Name:MACON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-798-7029
Mailing Address - Street 1:PO BOX 1306
Mailing Address - Street 2:
Mailing Address - City:GRANITE QUARRY
Mailing Address - State:NC
Mailing Address - Zip Code:28072-1306
Mailing Address - Country:US
Mailing Address - Phone:704-798-7029
Mailing Address - Fax:704-279-4071
Practice Address - Street 1:730 HUMMINGBIRD CIR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28146-2247
Practice Address - Country:US
Practice Address - Phone:704-798-7029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-080-099320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities