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General NPI Number Information
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NPI Number | 1770622524
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Entity Type | Organization
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Legal Business Name | CLASSIC CARE FAMILY SERVICES INC.
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 05/09/2012
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Provider Practice Location Address
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Address Line | 1118 GRECADE ST
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City | GREENSBORO
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State | NC
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Zip | 27408-8710
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Country | US
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Telephone | 336-601-3298
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 78026
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City | GREENSBORO
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State | NC
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Zip | 27427-8026
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Country | US
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Telephone | 336-601-3298
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. REGINA R RATLIFF
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Credential |
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Telephone | 336-601-3298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MKL041647
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License Number State | NC
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