Exodus Peer to Peer Recovery Center

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Legal business name

EXODUS PEER TO PEER RECOVERY CENTER

Practice address

419 E Main St
Farmington, NM 87401-2707

Phone

(505) 819-9740

NPI assigned

Aug 9, 2011

Organization subpart

Yes

Parent organization

B'SORAH HOUSING AND SOCIAL SERVICE AGENCYAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. La Tonya Delilah Westrick, CPSW, PASTOR, FC

Title

Executive Director

Phone

(505) 819-9740

Specialties & licenses 4

Addresses

Other names 1

• Congregation Nevi'im Shavuot Other name

Part of

Exodus Peer to Peer Recovery Center

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1312848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312848000000",
    "number": "1376822296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "419 E. MAIN STREET",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "87402",
            "telephone_number": "505-819-9740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 E MAIN ST",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874012707",
            "telephone_number": "505-819-9740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXODUS PEER TO PEER RECOVERY CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "B'SORAH HOUSING AND SOCIAL SERVICE AGENCY",
        "enumeration_date": "2011-08-09",
        "last_updated": "2011-08-09",
        "status": "A",
        "authorized_official_last_name": "WESTRICK",
        "authorized_official_first_name": "LA TONYA",
        "authorized_official_middle_name": "DELILAH",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "505-819-9740",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CPSW, PASTOR, FC"
    },
    "taxonomies": [
        {
            "code": "101YP1600X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Pastoral",
            "state": "NM",
            "license": null,
            "primary": false
        },
        {
            "code": "133NN1002X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "NM",
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": "NM",
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Community Health Worker",
            "state": "NM",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Congregation Nevi'im Shavuot",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kristy Jo Ella Evans, COTA
• Justin Ewell, DMD
• Carol Lynn Ewing, CNM
• Excel Case Management, Inc.
• Exceptional Physicians Group Farmington Hospital PLLC
• Eye Associates of New Mexico, LTD.
• Eyemart Express LLC
• Eyemart Express LTD
• Michael Chantz Eyring, PHARMD
• Maryann Fagrelius, M.A. CCC-SP

• All providers in Farmington, NM
• Community Health Worker in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.