Provider Demographics
NPI:1942345178
Name:ALASKA CONSUMER DIRECT PERSONAL CARE, LLC
Entity Type:Organization
Organization Name:ALASKA CONSUMER DIRECT PERSONAL CARE, LLC
Other - Org Name:CONSUMER DIRECT CARE NETWORK ALASKA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/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:406-541-1900
Mailing Address - Fax:
Practice Address - Street 1:615 E 82ND AVE
Practice Address - Street 2:STE 101
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-3153
Practice Address - Country:US
Practice Address - Phone:907-222-2652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK171M00000X
251B00000X, 251K00000X, 253Z00000X, 3747P1801X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM6102Medicaid
AKPCG3172Medicaid
AKCM6101Medicaid
AKCM54531Medicaid
AKPCG3173Medicaid
AKPCG3171Medicaid
AKCMG317Medicaid
AKHC0317Medicaid
AKPCG317Medicaid