Provider Demographics
NPI:1093253288
Name:CAROLINA CLASSIC SENIOR CARE, LLC
Entity Type:Organization
Organization Name:CAROLINA CLASSIC SENIOR CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:MUZE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PHD, CSCM
Authorized Official - Phone:336-745-8862
Mailing Address - Street 1:1835 AUSTIN PLACE LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-4680
Mailing Address - Country:US
Mailing Address - Phone:336-745-8862
Mailing Address - Fax:336-793-3265
Practice Address - Street 1:1835 AUSTIN PLACE LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-4680
Practice Address - Country:US
Practice Address - Phone:336-745-8862
Practice Address - Fax:336-793-3265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC253Z00000X
311ZA0620X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No385H00000XRespite Care FacilityRespite Care