CREOLIA'S HOUSE LLC (NPI# 1235311994) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235311994 |
| Entity Type | Organization |
| Organization Name | CREOLIA'S HOUSE LLC |
| Practice Address |
627 Lake St Eden NC 27288-4323 |
| Mailing Address |
1074 Candy Creek Rd Reidsville NC 27320-1631 |
| Practice Telephone | 3366354999 |
| Practice Fax Number | 3366354999 |
| Mailing Telephone | 3366340593 |
| Mailing Fax Number | 3366340593 |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2008-06-23 |
| Authorized Official Name | LATONYA RICE (DIRECTOR) |
| Authorized Official Telephone | 3366340593 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | NC | Residential Treatment Facilities |
| Street Address |
627 LAKE ST |
| City | EDEN |
| State | NC |
| Zip Code | 27288-4323 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639781297 | Bailey Shea Scism | Pharmacist | 103 W Stadium Dr., Eden, NC 27288 | 2020-08-17 |
| 1538640628 | Donnell Corey Brown Jr. | Technician | 519 Orchard Drive, Eden, NC 27288 | 2018-08-27 |
| 1851728182 | Linda Mitchell | Physical Therapy Assistant | 114 E Kings Hwy, Eden, NC 27288 | 2013-10-01 |
| 1033341573 | Central State of The Carolinas, Inc. | Day Training, Developmentally Disabled Services | 229 Cedar St., Eden, NC 27288 | 2009-08-18 |
| 1114186483 | Enrich Cosmetic Center | Internal Medicine | 406 B Thompson St, Eden, NC 27288 | 2008-06-03 |
| 1265630891 | John R. Dabbs Jr. Dc PC | Preferred Provider Organization | 405 Boone Road, Eden, NC 27288 | 2007-07-05 |
| 1235283961 | James Harrison Eggleston | Dentist | 113 West Arbor Lane, Eden, NC 27288 | 2007-01-22 |
| 1962563940 | Barbara Collins Tanner | Nurse Practitioner | 134 North Pierce Street, Morehead High School Student Health Center, Eden, NC 27288 | 2006-12-13 |
| 1285690974 | Robert Maurice Vaughn | Chiropractor | 405 Boone Rd, Eden, NC 27288 | 2006-04-22 |
| 1619930666 | Direct Respiratory Services | Durable Medical Equipment & Medical Supplies | 302a North Pierce Street, Eden, NC 27288 | 2006-04-10 |
| Find all providers in zip 27288 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316286222 | Guiding Light | Residential Treatment Facility, Emotionally Disturbed Children | 166 Hampton Rd, Eden, NC 27288-7945 | 2013-02-13 |
| 1821353558 | Directed Path, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 1308 E Stadium Dr, Eden, NC 27288-3812 | 2012-07-09 |
| 1346415809 | Central Care Division, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 907 Williams St, Eden, NC 27288-5515 | 2008-04-25 |
| 1104090562 | New Abundant Living 3 | Residential Treatment Facility, Emotionally Disturbed Children | 1014 West Ave, Eden, NC 27288-6430 | 2008-04-16 |
| 1003938226 | Daystar Youth Services, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 1033 Klyce St, Eden, NC 27288-6327 | 2007-04-06 |
| 1912029133 | Daystar Youth Services, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 1310 Norman Dr, Eden, NC 27288-5944 | 2007-04-06 |
| 1558482919 | Daystar Youth Services, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 210 Cedar St, Eden, NC 27288-5502 | 2007-04-03 |
| 1588704514 | Abundant Living Group Home, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 438 Creekridge Dr, Eden, NC 27288-2817 | 2007-02-07 |
| 1437394145 | Exceptional Care Professional Services, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 797 Red Clay Rd, Eden, NC 27288-2425 | 2008-12-09 |
| 1164616835 | Abundant Living Group Home, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 438 Creekridge Dr, Eden, NC 27288-2817 | 2007-09-05 |
| Find all providers in EDEN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.