Healthcare Provider Details

I. General information

NPI: 1740376292
Provider Name (Legal Business Name): NEW MEXICO CONSUMER DIRECT PERSONAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 SAN PEDRO DR NE STE 400
ALBUQUERQUE NM
87113-2476
US

IV. Provider business mailing address

100 CONSUMER DIRECT WAY
MISSOULA MT
59808-5037
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-3116
  • Fax:
Mailing address:
  • Phone: 406-532-1900
  • Fax: 406-532-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: HOLLY STEPHENS
Title or Position: LEGAL MANAGER
Credential:
Phone: 406-532-1929