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
1	251B00000X	Case Management Agency		NC

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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