Provider Demographics
NPI:1497031033
Name:DIRECTCARE COMMUNITY BASE SERVICES,LLC
Entity Type:Organization
Organization Name:DIRECTCARE COMMUNITY BASE SERVICES,LLC
Other - Org Name:MENTAL HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRANCE
Authorized Official - Middle Name:TODD
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 1:2732 ROZZELLES FERRY RD
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-3233
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:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management