Masada House Inc

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

0154441 Issued in NM

Legal business name

MASADA HOUSE INC

Practice address

610 N Dustin Ave
Farmington, NM 87401

Phone

(505) 325-9205

Fax

(505) 325-9216

NPI assigned

Feb 10, 2015

Organization subpart

No

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

Authorized official

Name

Shawna B Riley, BS LADAC

Title

Executive Director

Phone

(505) 325-9205

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1423526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423526400000",
    "number": "1922499136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 N DUSTIN AVE",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "87401",
            "telephone_number": "505-325-9205",
            "fax_number": "505-325-9216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 N DUSTIN AVE",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "87401",
            "telephone_number": "505-325-9205",
            "fax_number": "505-325-9216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASADA HOUSE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-10",
        "last_updated": "2015-02-10",
        "status": "A",
        "authorized_official_last_name": "RILEY",
        "authorized_official_first_name": "SHAWNA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "505-325-9205",
        "authorized_official_credential": "BS LADAC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NM",
            "license": "0154441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joann Nicole Martinez
• John Andrew Martinez
• Rolondo Martinez
• Shianne T Martinez, LMHC
• Kyle James Martinos, DPT
• Denise Mascarenas, LSAA
• Candy Marie Maslen
• Kelli Matajcich, P-LMHC
• Camille Matthews, LISW BCD
• Averil Mauelito Lee, BA

• Addiction (Substance Use Disorder) Counselor in Farmington, NM
• Providers in Farmington, NM by specialty
• Addiction (Substance Use Disorder) Counselor in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2015; 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.