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General NPI Number Information
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NPI Number | 1497640007
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Entity Type | Organization
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Legal Business Name | KRYSTAL'S HOUSE, INC
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Dates
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Enumeration Date | 06/12/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 83 WHITE HORSE RD SUITE 301
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City | PIKEVILLE
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State | NC
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Zip | 27863
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Country | US
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Telephone | 919-709-0009
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Fax | 877-213-7622
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Provider Business Mailing Address
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Address Line | 1700 E ASH ST STE 301
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City | GOLDSBORO
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State | NC
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Zip | 27530-4097
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Country | US
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Telephone | 877-213-3533
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Fax | 877-213-3533
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. KENNETH HODGES
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Credential | RN
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Telephone | 877-213-3533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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