Provider Demographics
NPI:1144494402
Name:CROSSNORE COMMUNITIES FOR CHILDREN
Entity type:Organization
Organization Name:CROSSNORE COMMUNITIES FOR CHILDREN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-845-2525
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:CROSSNORE
Mailing Address - State:NC
Mailing Address - Zip Code:28616-0249
Mailing Address - Country:US
Mailing Address - Phone:828-733-4305
Mailing Address - Fax:828-733-3250
Practice Address - Street 1:100 DAR DR
Practice Address - Street 2:
Practice Address - City:CROSSNORE
Practice Address - State:NC
Practice Address - Zip Code:28616-2861
Practice Address - Country:US
Practice Address - Phone:828-733-4305
Practice Address - Fax:828-733-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 1041C0700X, 320800000X
NC034-166251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental IllnessGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102468Medicaid