# KRYSTALS HOUSE, LLC

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

## Provider details

- **NPI number:** 1336271691
- **Authorized official:** MRS. CAROLYN HODGES BRYANT (OWNER)
- **Authorized official phone:** (252) 315-4420

## Contact information

- **Practice address:** 83 WHITE HORSE RD, PIKEVILLE, NC 27863-8365
- **Practice address phone:** (252) 747-2988
- **Practice address fax:** (252) 747-4330
- **Mailing address:** 83 WHITE HORSE RD, PIKEVILLE, NC 27863-8365
- **Mailing address phone:** (252) 747-2988
- **Mailing address fax:** (252) 747-2988

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | MHL 040-028 | NC | Yes |

## Other

- **Enumeration date:** 03/12/2007
- **Last updated:** 11/02/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7805534 | — | NC |