Organization
KRYSTAL'S HOUSE, INC
Active
Other names
CPSHomecare
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH HODGES RN (DIRECTOR)
(877) 213-3533
Entity
Organization
Contact information
Practice address
83 WHITE HORSE RD, SUITE 301, PIKEVILLE, NC 27863
(919) 709-0009
(877) 213-7622
Mailing address
1700 E ASH ST STE 301, GOLDSBORO, NC 27530-4097
(877) 213-3533
(877) 213-3533
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578856266
—
NC
Enumeration date
06/12/2025
Last updated
06/12/2025
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