Provider Demographics
NPI:1275678419
Name:DIRECT CASE MANAGEMENT, LLC
Entity Type:Organization
Organization Name:DIRECT CASE MANAGEMENT, LLC
Other - Org Name:DIRECT HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDERICK -O
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-363-6579
Mailing Address - Street 1:8224 PARK LN
Mailing Address - Street 2:SUITE 114
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-6011
Mailing Address - Country:US
Mailing Address - Phone:214-363-6579
Mailing Address - Fax:214-363-3981
Practice Address - Street 1:8224 PARK LN
Practice Address - Street 2:SUITE 114
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-6011
Practice Address - Country:US
Practice Address - Phone:214-363-6579
Practice Address - Fax:214-363-3981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0071637332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4965550001Medicare NSC