Healthcare Provider Details

I. General information

NPI: 1093253288
Provider Name (Legal Business Name): CAROLINA CLASSIC SENIOR CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2017
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1922 S MARTIN LUTHER KING JR DR
WINSTON SALEM NC
27107-1361
US

IV. Provider business mailing address

1922 S MARTIN LUTHER KING JR DR
WINSTON SALEM NC
27107-1361
US

V. Phone/Fax

Practice location:
  • Phone: 336-464-3124
  • Fax: 336-734-6717
Mailing address:
  • Phone: 336-464-3124
  • Fax: 336-734-6917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DR. RUTH MUZE
Title or Position: DIRECTOR
Credential: RN, PHD, CSCM
Phone: 336-745-8862