Provider Demographics
NPI:1154456366
Name:CONSUMER DIRECT PERSONAL CARE, LLC
Entity type:Organization
Organization Name:CONSUMER DIRECT PERSONAL CARE, LLC
Other - Org Name:
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:406-532-8573
Practice Address - Street 1:100 CONSUMER DIRECT WAY
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-5037
Practice Address - Country:US
Practice Address - Phone:406-532-1900
Practice Address - Fax:406-532-8573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT251E00000X
251S00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT470883Medicaid
MT601664Medicaid