Provider Demographics
NPI:1023363520
Name:CARRISMA HOME CARE, LLC
Entity type:Organization
Organization Name:CARRISMA HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-403-3677
Mailing Address - Street 1:P. O. BOX 26611
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27114-6611
Mailing Address - Country:US
Mailing Address - Phone:336-765-0806
Mailing Address - Fax:
Practice Address - Street 1:1396 OLD MILL CIR
Practice Address - Street 2:SUITE 1-A
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2976
Practice Address - Country:US
Practice Address - Phone:336-765-0806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4558253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHC4558OtherHOME CARE SERVICES: IN-HOME AIDE, COMPANION, SITTER, RESPITE