Organization
KRYSTALS HOUSE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CAROLYN HODGES BRYANT (OWNER)
(252) 315-4420
Entity
Organization
Contact information
Practice address
83 WHITE HORSE RD, PIKEVILLE, NC 27863-8365
(252) 747-2988
(252) 747-4330
Mailing address
83 WHITE HORSE RD, PIKEVILLE, NC 27863-8365
(252) 747-2988
(252) 747-2988
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
MHL 040-028
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805534
—
NC
Enumeration date
03/12/2007
Last updated
11/02/2016
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