Provider Demographics
NPI:1497896658
Name:SOS INC
Entity Type:Organization
Organization Name:SOS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:WENDELL
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:910-347-2001
Mailing Address - Street 1:2 DEWITT ST # 6
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-5649
Mailing Address - Country:US
Mailing Address - Phone:910-347-2001
Mailing Address - Fax:910-347-4001
Practice Address - Street 1:215 MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28545-6333
Practice Address - Country:US
Practice Address - Phone:910-219-7938
Practice Address - Fax:910-353-1436
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-09
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418855Medicaid
NC8301942Medicaid
NC8301271Medicaid
NC8301271BMedicaid