Provider Demographics
NPI:1538649983
Name:CONSUMER DIRECT CARE NETWORK VIRGINIA
Entity Type:Organization
Organization Name:CONSUMER DIRECT CARE NETWORK VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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:406-532-1929
Mailing Address - Fax:
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:406-532-1929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONSUMER DIRECT HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-15
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty