Healthcare Provider Details

I. General information

NPI: 1649511056
Provider Name (Legal Business Name): COVENANT CONSUMER DIRECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 12/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 N. 44TH STREET
PHOENIX AZ
85018-7228
US

IV. Provider business mailing address

100 CONSUMER DIRECT WAY
MISSOULA MT
59808-5037
US

V. Phone/Fax

Practice location:
  • Phone: 480-354-5829
  • Fax: 877-398-7967
Mailing address:
  • Phone: 406-539-1900
  • Fax: 406-532-1922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. BEN BLEDSOE
Title or Position: PRESIDENT/CEO
Credential:
Phone: 406-532-2001