Active NPI
Chantelle Deitrich
- Case Manager/Care Coordinator
- Taos, NM
National Provider Identifier
1104544386
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 105 Bertha Rd Ste B
Taos, NM 87571-7148 - Phone
- (575) 758-4297
- NPI assigned
- Aug 15, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | |||
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
105 Bertha Rd Ste B
Taos, NM 87571-7148
Mailing address
422 Camino de la Merced
Taos, NM 87571-5285
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nonviolence Works, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Taos, NM
- NPI 1376777607
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1660521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676246400000",
"number": "1104544386",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "422 CAMINO DE LA MERCED",
"city": "TAOS",
"state": "NM",
"postal_code": "875715285"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 BERTHA RD STE B",
"city": "TAOS",
"state": "NM",
"postal_code": "875717148",
"telephone_number": "575-758-4297"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEITRICH",
"first_name": "CHANTELLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-08-15",
"last_updated": "2023-02-13",
"certification_date": "2023-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": null,
"license": null,
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Taos, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.