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NPI Code Detail

MEDICARE: DIRECTCARE COMMUNITY BASE SERVICES,LLC

MEDICARE: DIRECTCARE COMMUNITY BASE SERVICES,LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management AgencyNC

General Provider Information

NPI Number : 1497031033
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIRECTCARE COMMUNITY BASE SERVICES,LLC
Provider Business Mailing Address
First Line : PO BOX 261
Second Line :
City : CROUSE
State : NC
Zip : 28033-0261
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2732 ROZZELLES FERRY RD
Second Line : SUITE B
City : CHARLOTTE
State : NC
Zip : 28208-3233
Country : US
Telephone Number : 828-305-4330
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MR. BARRANCE TODD ROBERTS
Credential :
Telephone Number : 828-305-4330
Provider Enumeration Date : 10/27/2011
Last Update Date : 10/27/2011

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