Provider Demographics
NPI:1154466373
Name:CONSUMER DIRECT SERVICES FOR NEVADA, LLC
Entity Type:Organization
Organization Name:CONSUMER DIRECT SERVICES FOR NEVADA, LLC
Other - Org Name:CONSUMER DIRECT PERSONAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEDSOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-532-2001
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:406-541-1700
Mailing Address - Fax:
Practice Address - Street 1:1005 TERMINAL WAY
Practice Address - Street 2:STE 118
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2120
Practice Address - Country:US
Practice Address - Phone:775-786-4999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251E00000X
253Z00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100500005Medicaid
NV100501094Medicaid
NV100501014Medicaid