Provider Demographics
NPI:1518232859
Name:CONSUMER DIRECT FOR TENNESSEE, LLC
Entity Type:Organization
Organization Name:CONSUMER DIRECT FOR TENNESSEE, LLC
Other - Org Name:CONSUMER DIRECT CARE NETWORK TENNESSEE
Other - Org Type:Doing Business As
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:JD
Authorized Official - Phone:406-532-2926
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:
Practice Address - Street 1:2 VANTAGE WAY
Practice Address - Street 2:THE IVY
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228
Practice Address - Country:US
Practice Address - Phone:406-532-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
No251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1942345178Medicaid