=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295677235
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ESPANOLA PATHWAYS SHELTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2026
-----------------------------------------------------
Last Update Date | 04/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 628 N RIVERSIDE DR STE A
-----------------------------------------------------
City | ESPANOLA
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87532-2620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-753-4453
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 628 N RIVERSIDE DR STE A
-----------------------------------------------------
City | ESPANOLA
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87532-2620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DENA MOSCOLA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-886-1974
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------