# CREOLIA'S HOUSE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235311994
- **Authorized official:** LATONYA RICE (DIRECTOR)
- **Authorized official phone:** (336) 634-0593

## Contact information

- **Practice address:** 627 LAKE ST, EDEN, NC 27288-4323
- **Practice address phone:** (336) 635-4999
- **Practice address fax:** (336) 635-4999
- **Mailing address:** 1074 CANDY CREEK RD, REIDSVILLE, NC 27320-1631
- **Mailing address phone:** (336) 634-0593
- **Mailing address fax:** (336) 634-0593

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | NC | Yes |

## Other

- **Enumeration date:** 12/04/2007
- **Last updated:** 06/23/2008