=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740376292
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW MEXICO CONSUMER DIRECT PERSONAL CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 08/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8220 SAN PEDRO DR NE STE 400
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87113-2476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-884-3116
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 CONSUMER DIRECT WAY
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59808-5037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-532-1900
-----------------------------------------------------
Fax | 406-532-1901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LEGAL MANAGER
-----------------------------------------------------
Name | HOLLY STEPHENS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 406-532-1929
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------