Provider Demographics
NPI:1740376292
Name:NEW MEXICO CONSUMER DIRECT PERSONAL CARE, LLC
Entity type:Organization
Organization Name:NEW MEXICO CONSUMER DIRECT PERSONAL CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LEGAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-532-1929
Mailing Address - Street 1:100 CONSUMER DIRECT WAY
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-5037
Mailing Address - Country:US
Mailing Address - Phone:406-532-1900
Mailing Address - Fax:406-532-1901
Practice Address - Street 1:8220 SAN PEDRO DR NE STE 400
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2476
Practice Address - Country:US
Practice Address - Phone:505-884-3116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONSUMER DIRECT HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-04
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM22554254Medicaid
NM01926250Medicaid
NM55821065Medicaid
NM84385359Medicaid
NM57575533Medicaid