NPIMap

Organization Active NPI

Youth Odyssey Inc.

Doing business as Wilderness Odyssey

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Ruidoso, NM
National Provider Identifier
1952549875
Registry record updated Jan 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
4737 Issued in NM
Legal business name
YOUTH ODYSSEY INC.
Doing business as
Wilderness Odyssey
Practice address
605 White Mountain Meadows Dr
Ruidoso, NM 88345-5816
Phone
(877) 834-4430
Fax
(575) 258-3907
NPI assigned
Jan 30, 2009
Last updated
Jan 30, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2009

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

Authorized official

Name
Jon Robert Worbets, LPCC
Title
Executive Director
Phone
(877) 834-4430

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 4737 NM Primary

Addresses

Primary practice location

605 White Mountain Meadows Dr
Ruidoso, NM 88345-5816

Mailing address

PO Box 1065
Ruidoso, NM 88355-1065
Phone (877) 834-4430

Other names 1

  • Wilderness Odyssey Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1233273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233273600000",
    "number": "1952549875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1065",
            "city": "RUIDOSO",
            "state": "NM",
            "postal_code": "883551065",
            "telephone_number": "877-834-4430",
            "fax_number": "575-258-3907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 WHITE MOUNTAIN MEADOWS DR",
            "city": "RUIDOSO",
            "state": "NM",
            "postal_code": "883455816",
            "telephone_number": "877-834-4430",
            "fax_number": "575-258-3907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUTH ODYSSEY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-30",
        "last_updated": "2009-01-30",
        "status": "A",
        "authorized_official_last_name": "WORBETS",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "877-834-4430",
        "authorized_official_credential": "LPCC"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NM",
            "license": "4737",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wilderness Odyssey",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ruidoso, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2009; 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.