NPIMap

Organization Active NPI

Direccare Behavioral Services,Inc

  • Community/Behavioral Health Agency
  • Elizabethtown, NC
National Provider Identifier
1780879825
Registry record updated Sep 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
DIRECCARE BEHAVIORAL SERVICES,INC
Practice address
129 West Broad St.
Suite C
Elizabethtown, NC 28337-9005
Phone
(910) 872-0013
Fax
(910) 872-0019
NPI assigned
Sep 12, 2007
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mr. Dereck Coe
Title
Co-Owner
Phone
(910) 872-0013

National Provider Directory

National Provider Directory
Tax ID family
Direccare Behavioral Services Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

129 W Broad St
Ste C
Elizabethtown, NC 28337
Phone (910) 872-0013

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

129 West Broad St.
Suite C
Elizabethtown, NC 28337-9005

Mailing address

63 Pridgen Rd
Lumberton, NC 28358-9726

Other identifiers 3

NPPES NPI Registry
IdentifierTypeStateIssuer
8301855HMedicaidNC
8301855GMedicaidNC
8301855BMedicaidNC

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 12, 2007.

{
    "created_epoch": "1189555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189555200000",
    "number": "1780879825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 PRIDGEN RD",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283589726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 WEST BROAD ST.",
            "address_2": "SUITE C",
            "city": "ELIZABETHTOWN",
            "state": "NC",
            "postal_code": "283379005",
            "telephone_number": "910-872-0013",
            "fax_number": "910-872-0019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIRECCARE BEHAVIORAL SERVICES,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-12",
        "last_updated": "2007-09-12",
        "status": "A",
        "authorized_official_last_name": "COE",
        "authorized_official_first_name": "DERECK",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "910-872-0013",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301855H",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301855G",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301855B",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabethtown, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.