Healthcare Provider Details

I. General information

NPI: 1780877076
Provider Name (Legal Business Name): SOUTHERN CROSS COMMUNITY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 WRIGHTSVILLE AVE SUITE 114
WILMINGTON NC
28403-2406
US

IV. Provider business mailing address

PO BOX 656
TABOR CITY NC
28463-0656
US

V. Phone/Fax

Practice location:
  • Phone: 910-763-3773
  • Fax: 910-763-3799
Mailing address:
  • Phone: 843-716-6000
  • Fax: 843-716-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM DALE HUDSON SR.
Title or Position: PRESIDENT/CEO
Credential: MS, MED, MDIV
Phone: 910-653-2007