Provider Demographics
NPI:1972656577
Name:COMMUNITY RESIDENTIAL SUPPORTIVE SERVICE HOME HEALTH INC
Entity Type:Organization
Organization Name:COMMUNITY RESIDENTIAL SUPPORTIVE SERVICE HOME HEALTH INC
Other - Org Name:CRSS HOME HEALTH INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-658-7586
Mailing Address - Street 1:2929 BREEZEWOOD AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5357
Mailing Address - Country:US
Mailing Address - Phone:910-779-2944
Mailing Address - Fax:910-835-0361
Practice Address - Street 1:2929 BREEZEWOOD AVE STE 202
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5357
Practice Address - Country:US
Practice Address - Phone:910-779-2944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2214251E00000X
253Z00000X, 253Z00000X, 332U00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600913Medicaid
NCHC6832Medicaid
NC6600747Medicaid
NCHC5970Medicaid
NC3409290OtherCAP DA
NC6600913OtherCAP CH
NCHC1972Medicaid
NCHC6940Medicaid
NC6600913OtherCAP CHOICE