Provider Demographics
NPI:1821209321
Name:SOUTHERN CROSS COMMUNITY SERVICES, INC
Entity Type:Organization
Organization Name:SOUTHERN CROSS COMMUNITY SERVICES, INC
Other - Org Name:SOUTHERN CROSS MENTAL HEALTH CENTERS
Other - Org Type:Doing Business As
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:MS, MED, MDIV
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 1:674 OCEAN HWY W
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4048
Practice Address - Country:US
Practice Address - Phone:910-755-7001
Practice Address - Fax:910-775-7005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare