Provider Demographics
NPI: | 1205931987 |
---|---|
Name: | HORIZON HEALTH AND WELLNESS, INC. |
Entity type: | Organization |
Organization Name: | HORIZON HEALTH AND WELLNESS, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | REVENUE CYCLE DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ELIZABETH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | RODRIGUEZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 520-876-1848 |
Mailing Address - Street 1: | 625 N PLAZA DR |
Mailing Address - Street 2: | |
Mailing Address - City: | APACHE JUNCTION |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85120-5501 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 480-983-0065 |
Mailing Address - Fax: | 480-671-4541 |
Practice Address - Street 1: | 415 W BASELINE SPUR |
Practice Address - Street 2: | |
Practice Address - City: | GLOBE |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85501 |
Practice Address - Country: | US |
Practice Address - Phone: | 928-402-9297 |
Practice Address - Fax: | 928-402-9414 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | HORIZON HEALTH AND WELLNESS, INC. |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-09-14 |
Last Update Date: | 2024-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AZ | 101YA0400X, 103TC1900X, 104100000X, 106H00000X, 163WP0808X, 2084N0400X, 2084P0800X, 363LP0808X, 101YP2500X | |
261QC1500X, 261QM0801X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
No | 163WP0808X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 261QC1500X | Ambulatory Health Care Facilities | Clinic/Center | Community Health | Group - Multi-Specialty |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AZ | 401711 | Medicaid | |
AZ | BH2484 | Other | OBHL LICENSE |
AZ | 401711 | Medicaid |