Provider Demographics
NPI:1417398611
Name:DIRECTCARE COMMUNITY BASED SERVICE, LLC
Entity Type:Organization
Organization Name:DIRECTCARE COMMUNITY BASED SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BARRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-305-4330
Mailing Address - Street 1:PO BOX 261
Mailing Address - Street 2:
Mailing Address - City:CROUSE
Mailing Address - State:NC
Mailing Address - Zip Code:28033-0261
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:156 SCHOOL ROAD
Practice Address - Street 2:202
Practice Address - City:MILL SPRING
Practice Address - State:NC
Practice Address - Zip Code:28756-0202
Practice Address - Country:US
Practice Address - Phone:828-305-4330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health