Provider Demographics
NPI:1780879825
Name:DIRECCARE BEHAVIORAL SERVICES,INC
Entity type:Organization
Organization Name:DIRECCARE BEHAVIORAL SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DERECK
Authorized Official - Middle Name:
Authorized Official - Last Name:COE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-872-0013
Mailing Address - Street 1:63 PRIDGEN RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-9726
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:129 WEST BROAD ST.
Practice Address - Street 2:SUITE C
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-9005
Practice Address - Country:US
Practice Address - Phone:910-872-0013
Practice Address - Fax:910-872-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301855HMedicaid
NC8301855GMedicaid
NC8301855BMedicaid