Provider Demographics
NPI:1659431021
Name:DIRECTCARE COMMUNITY BASE SERVICES,LLC
Entity Type:Organization
Organization Name:DIRECTCARE COMMUNITY BASE SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
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:828-305-4330
Mailing Address - Fax:
Practice Address - Street 1:106 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-3913
Practice Address - Country:US
Practice Address - Phone:828-303-4330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300188Medicaid