1740376292 NPI number — NEW MEXICO CONSUMER DIRECT PERSONAL CARE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740376292 NPI number — NEW MEXICO CONSUMER DIRECT PERSONAL CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW MEXICO CONSUMER DIRECT PERSONAL CARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740376292
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 CONSUMER DIRECT WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSOULA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59808-5037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-532-1900
Provider Business Mailing Address Fax Number:
406-532-1901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8220 SAN PEDRO DR NE STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87113-2476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-884-3116
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STEPHENS
Authorized Official First Name:
HOLLY
Authorized Official Middle Name:
Authorized Official Title or Position:
LEGAL MANAGER
Authorized Official Telephone Number:
406-532-1929

Provider Taxonomy Codes

  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 22554254 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01926250 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 55821065 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84385359 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 57575533 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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