CREOLIA'S HOUSE LLC


Address: 627 Lake St, Eden, NC 27288-4323
Phone: 3366354999

CREOLIA'S HOUSE LLC (NPI# 1235311994) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1235311994
Entity Type Organization
Organization Name CREOLIA'S HOUSE LLC
Practice Address 627 Lake St
Eden
NC 27288-4323
Mailing Address 1074 Candy Creek Rd
Reidsville
NC 27320-1631
Practice Telephone 3366354999
Practice Fax Number 3366354999
Mailing Telephone 3366340593
Mailing Fax Number 3366340593
Enumeration Date 2007-12-04
Last Update Date 2008-06-23
Authorized Official Name LATONYA RICE (DIRECTOR)
Authorized Official Telephone 3366340593
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 322D00000X Residential Treatment Facility, Emotionally Disturbed Children NC Residential Treatment Facilities

Office Location

Street Address 627 LAKE ST
City EDEN
State NC
Zip Code 27288-4323

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1639781297 Bailey Shea Scism Pharmacist 103 W Stadium Dr., Eden, NC 27288 2020-08-17
1538640628 Donnell Corey Brown Jr. Technician 519 Orchard Drive, Eden, NC 27288 2018-08-27
1851728182 Linda Mitchell Physical Therapy Assistant 114 E Kings Hwy, Eden, NC 27288 2013-10-01
1033341573 Central State of The Carolinas, Inc. Day Training, Developmentally Disabled Services 229 Cedar St., Eden, NC 27288 2009-08-18
1114186483 Enrich Cosmetic Center Internal Medicine 406 B Thompson St, Eden, NC 27288 2008-06-03
1265630891 John R. Dabbs Jr. Dc PC Preferred Provider Organization 405 Boone Road, Eden, NC 27288 2007-07-05
1235283961 James Harrison Eggleston Dentist 113 West Arbor Lane, Eden, NC 27288 2007-01-22
1962563940 Barbara Collins Tanner Nurse Practitioner 134 North Pierce Street, Morehead High School Student Health Center, Eden, NC 27288 2006-12-13
1285690974 Robert Maurice Vaughn Chiropractor 405 Boone Rd, Eden, NC 27288 2006-04-22
1619930666 Direct Respiratory Services Durable Medical Equipment & Medical Supplies 302a North Pierce Street, Eden, NC 27288 2006-04-10
Find all providers in zip 27288

Taxonomy Information

Taxonomy Code 322D00000X
Grouping Residential Treatment Facilities
Classification Residential Treatment Facility, Emotionally Disturbed Children

Taxonomy Definition

A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment.
Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1316286222 Guiding Light Residential Treatment Facility, Emotionally Disturbed Children 166 Hampton Rd, Eden, NC 27288-7945 2013-02-13
1821353558 Directed Path, LLC Residential Treatment Facility, Emotionally Disturbed Children 1308 E Stadium Dr, Eden, NC 27288-3812 2012-07-09
1346415809 Central Care Division, LLC Residential Treatment Facility, Emotionally Disturbed Children 907 Williams St, Eden, NC 27288-5515 2008-04-25
1104090562 New Abundant Living 3 Residential Treatment Facility, Emotionally Disturbed Children 1014 West Ave, Eden, NC 27288-6430 2008-04-16
1003938226 Daystar Youth Services, Inc. Residential Treatment Facility, Emotionally Disturbed Children 1033 Klyce St, Eden, NC 27288-6327 2007-04-06
1912029133 Daystar Youth Services, Inc. Residential Treatment Facility, Emotionally Disturbed Children 1310 Norman Dr, Eden, NC 27288-5944 2007-04-06
1558482919 Daystar Youth Services, Inc. Residential Treatment Facility, Emotionally Disturbed Children 210 Cedar St, Eden, NC 27288-5502 2007-04-03
1588704514 Abundant Living Group Home, Inc. Residential Treatment Facility, Emotionally Disturbed Children 438 Creekridge Dr, Eden, NC 27288-2817 2007-02-07
1437394145 Exceptional Care Professional Services, LLC Residential Treatment Facility, Emotionally Disturbed Children 797 Red Clay Rd, Eden, NC 27288-2425 2008-12-09
1164616835 Abundant Living Group Home, Inc Residential Treatment Facility, Emotionally Disturbed Children 438 Creekridge Dr, Eden, NC 27288-2817 2007-09-05
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Competitor

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City EDEN
Zip Code 27288

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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