1871991836 NPI number — HORIZON HEALTH AND WELLNESS, INC.

Table of content: (NPI 1871991836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871991836 NPI number — HORIZON HEALTH AND WELLNESS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HORIZON HEALTH AND WELLNESS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MOUNTAIN HEALTH & WELLNESS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871991836
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 N. PLAZA DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APACHE JUNCTION
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85120-5501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-983-0065
Provider Business Mailing Address Fax Number:
480-671-4541

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 N PLAZA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APACHE JUNCTION
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85120-5501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-983-0065
Provider Business Practice Location Address Fax Number:
480-288-5339
Provider Enumeration Date:
12/08/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MUDD
Authorized Official First Name:
NORMAN
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
480-983-0065

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  OTC6220 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PENDING . This is a "APPLYING FOR FQHC NEW PROVIDER TYPE C2" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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