1609255488 NPI number — HORIZON HEALTH AND WELLNESS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609255488 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:
Provider Other Organization Name Type Code:
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:
1609255488
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2016
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:
3180 E 40TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUMA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85365-7772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-344-9490
Provider Business Practice Location Address Fax Number:
480-288-5339
Provider Enumeration Date:
05/26/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ROYBAL-BROWN
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF DEVELOPMENT
Authorized Official Telephone Number:
480-474-5586

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  OTC6214 , 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)





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