MEDICARE: CROSSLAND GROUP FAMILY SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497910921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSLAND GROUP FAMILY SERVICES, INC.

Provider Business Mailing Address
First Line	:	1209 BRIARDALE RD
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27712-9776
Country	:	US
Telephone Number	:	919-699-6979
Fax Number	:

Provider Business Practice Location Address
First Line	:	1209 BRIARDALE RD
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27712-9776
Country	:	US
Telephone Number	:	919-699-6979
Fax Number	:

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	MS. EUGENIA KAYE CROSSLAND
Credential	:
Telephone Number	:	919-699-6979

Provider Enumeration Date	:	07/24/2008
Last Update Date	:	07/24/2008

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