Provider Demographics
NPI:1760678478
Name:CLASSIC COUNTRY CARE INC
Entity Type:Organization
Organization Name:CLASSIC COUNTRY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:MURPHY
Authorized Official - Last Name:MOZINGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-527-8944
Mailing Address - Street 1:288 HWY 11 S
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504
Mailing Address - Country:US
Mailing Address - Phone:252-527-8944
Mailing Address - Fax:252-527-2496
Practice Address - Street 1:288 HWY 11 S
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504
Practice Address - Country:US
Practice Address - Phone:252-527-8944
Practice Address - Fax:252-527-2496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL - 054-001310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802704Medicaid