Healthcare Provider Details

I. General information

NPI: 1093325177
Provider Name (Legal Business Name): DIRECT CARE MANAGEMENT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12150 TRIBUTARY POINT DR STE 200
RANCHO CORDOVA CA
95670-4531
US

IV. Provider business mailing address

12150 TRIBUTARY POINT DR STE 200
RANCHO CORDOVA CA
95670-4531
US

V. Phone/Fax

Practice location:
  • Phone: 888-478-4264
  • Fax: 888-413-0267
Mailing address:
  • Phone: 888-478-4264
  • Fax: 888-413-0267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: SHANNON TERRY LOVE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 888-478-4264