Creolia's House LLC

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

Legal business name

CREOLIA'S HOUSE LLC

Practice address

627 Lake St
Eden, NC 27288-4323

Phone

(336) 635-4999

Fax

(336) 635-4999

NPI assigned

Dec 4, 2007

Last updated

Jun 23, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Latonya Rice

Title

Director

Phone

(336) 634-0593

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214179200000",
    "number": "1235311994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1074 CANDY CREEK RD",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "273201631",
            "telephone_number": "336-634-0593",
            "fax_number": "336-634-0593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "627 LAKE ST",
            "city": "EDEN",
            "state": "NC",
            "postal_code": "272884323",
            "telephone_number": "336-635-4999",
            "fax_number": "336-635-4999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREOLIA'S HOUSE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-04",
        "last_updated": "2008-06-23",
        "status": "A",
        "authorized_official_last_name": "RICE",
        "authorized_official_first_name": "LATONYA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "336-634-0593"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Lisa K Corum, OT/L
• Jennifer Lillie Coulson, DPT
• Angela Crawford
• Rikki Lynn Creech
• Caroline Taylor Crockett
• Amanda Crouch, PHARMD
• Robert L Crouch, RPH, CPP, CFTS
• Audrey Howell D'Antuono, LPC
• Deborah S Dabbs, PT

• Emotionally Disturbed Childrens' Residential Treatment Facility in Eden, NC
• Providers in Eden, NC by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.