Provider Demographics
NPI:1528418621
Name:DIRECTCARE
Entity Type:Organization
Organization Name:DIRECTCARE
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 1:135 MICHELLE DR
Practice Address - Street 2:
Practice Address - City:ELLENBORO
Practice Address - State:NC
Practice Address - Zip Code:28040-7619
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:2016-06-20
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-081-115251B00000X
251S00000X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness