Healthcare Provider Details

I. General information

NPI: 1205938412
Provider Name (Legal Business Name): CROSSROADS SUPPORT SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 WAYNE MEMORIAL DRIVE SUITE C
GOLDSBORO NC
27534-2253
US

IV. Provider business mailing address

PO BOX 251
GOLDSBORO NC
27533-0251
US

V. Phone/Fax

Practice location:
  • Phone: 919-736-9242
  • Fax: 919-736-9299
Mailing address:
  • Phone: 919-736-9242
  • Fax: 919-736-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC 1678
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHC 1678
License Number StateNC

VIII. Authorized Official

Name: MR. THOMAS JOHNSON
Title or Position: PRESIDENT
Credential:
Phone: 919-736-9242