Provider Demographics
NPI:1497910921
Name:CROSSLAND GROUP FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:CROSSLAND GROUP FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:EUGENIA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:CROSSLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-699-6979
Mailing Address - Street 1:1209 BRIARDALE RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-9776
Mailing Address - Country:US
Mailing Address - Phone:919-699-6979
Mailing Address - Fax:
Practice Address - Street 1:1209 BRIARDALE RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27712-9776
Practice Address - Country:US
Practice Address - Phone:919-699-6979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC320900000XMedicaid