Organization · Type 2 NPI

Mogollon Treatment Center

Substance Abuse Rehabilitation Facility · Phoenix, AZ

NPI number 1750160511 Active

Practice location

5402 E Thomas Rd
Phoenix, AZ 85018-8107

Call (602) 516-2414 Map

Mailing address

306 W Aero Dr
Payson, AZ 85541-5405

Specialties and licenses

Taxonomy	Code	License
Substance Abuse Rehabilitation Facility Primary	324500000X	None listed

Substance Abuse Rehabilitation Facility: A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

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NPI record

NPI: 1750160511
Entity type: Organization (Type 2)
Issued: Sep 21, 2023
Last updated: Sep 21, 2023
Status: Active
Subpart: Yes of Mogollon Treatment Center

Other names

Paradise Valley Recovery · doing business as

Authorized official

Mr. Tyri Norman Blondal
Chief Operations Officer
(602) 516-2414

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1750160511

Mogollon Treatment Center's National Provider Identifier is 1750160511, issued on Sep 21, 2023. The primary taxonomy on file is Substance Abuse Rehabilitation Facility (324500000X), and the practice location is in Phoenix, AZ. The record was last updated on Sep 21, 2023.