MEDICARE: CROSSROADS SUPPORT 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	374U00000X	Home Health Aide	HC 1678	NC
2	251E00000X	Home Health Agency	HC 1678	NC

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205938412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSROADS SUPPORT SERVICES, INC

Provider Business Mailing Address
First Line	:	PO BOX 251
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27533-0251
Country	:	US
Telephone Number	:	919-736-9242
Fax Number	:	919-736-9299

Provider Business Practice Location Address
First Line	:	1316 WAYNE MEMORIAL DRIVE
Second Line	:	SUITE C
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-2253
Country	:	US
Telephone Number	:	919-736-9242
Fax Number	:	919-736-9299

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. THOMAS JOHNSON
Credential	:
Telephone Number	:	919-736-9242

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	07/09/2012

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Directions to “CROSSROADS SUPPORT SERVICES, INC ” Practice Location

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