NPIMap

Organization Active NPI

Horizon Health and Wellness, Inc.

  • Federally Qualified Health Center (FQHC)
  • Apache Junction, AZ
National Provider Identifier
1235560087
Registry record updated Apr 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
BH 3828 Issued in AZ
Legal business name
HORIZON HEALTH AND WELLNESS, INC.
Practice address
625 N Plaza Dr
Apache Junction, AZ 85120-5501
Phone
(480) 983-0065
Fax
(480) 288-5339
NPI assigned
Dec 4, 2013
Last updated
Apr 23, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Billie Holliday
Title
Chief Operating Officer
Phone
(480) 474-5586

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X BH 3828 AZ Primary

Addresses

Primary practice location

625 N Plaza Dr
Apache Junction, AZ 85120-5501

Mailing address

625 N. Plaza Drive
Apache Junction, AZ 85120-5501
Phone (480) 983-0065

Other identifiers 2

IdentifierTypeStateIssuer
OTC-5116OtherAZSTATE LICENSE NUMBER
OCT 6220OtherAZSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040202000450 AZ Part B Supplier - Clinic/Group Practice 6406759711 Receives reassigned benefits from 93 practitioners
37 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Queen Creek, AZ; Yuma, AZ; Oracle, AZ; Globe, AZ; Casa Grande, AZ; Florence, AZ; Apache Junction, AZ
O20140218001216 AZ Part A Provider - Federally Qualified Health Center (FQHC) 6406759711 Practice locations: Apache Junction, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235560087. Details of each certification follow.

Federally qualified health center certification: CCN 031912

Legal name
HORIZON HEALTH AND WELLNESS, INC.
Doing business as
MOUNTAIN HEALTH & WELLNESS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 4, 2014
Last certification
Feb 4, 2014
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1986 in AZ
Enrollment address
625 N Plaza Dr
Apache Junction, AZ 85120-5501

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 18

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 18

National Provider Directory

National Provider Directory
Tax ID family
Horizon Health Wellness in32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

Locations

625 N Plaza Dr
Apache Junction, AZ 85120
Phone (480) 282-6278

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Elizabeth Rodriguez Individual Corporate OfficerRevenue Cycle Officer May 16, 2018 0.05%
Benjamin Baxter Individual Corporate OfficerChief Financial Officer Oct 1, 2019 0.05%
Laura Larson-Huffaker Individual Corporate OfficerChief Executive Officer Oct 1, 2019 0.5%
Pamela Brotman Individual W-2 Managing EmployeeChief Quality Management Oct 1, 2019 0.01%
Bryan Alford Individual Corporate DirectorBoard of Directors Vice Chair Apr 1, 2016 0.01%
Raul Fiveash Individual Corporate DirectorBoard of Directors Vice Chair Oct 1, 2005 0.01%
Mike Farber Individual Corporate DirectorBoard of Directors Vice Chair Oct 1, 2005 0.01%
Brent Billingsley Individual Corporate DirectorBoard of Directors Vice Chair Oct 1, 2005 0.01%

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1386115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587600000000",
    "number": "1235560087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 N. PLAZA DRIVE",
            "city": "APACHE JUNCTION",
            "state": "AZ",
            "postal_code": "851205501",
            "telephone_number": "480-983-0065",
            "fax_number": "480-671-4541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 N PLAZA DR",
            "city": "APACHE JUNCTION",
            "state": "AZ",
            "postal_code": "851205501",
            "telephone_number": "480-983-0065",
            "fax_number": "480-288-5339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HORIZON HEALTH AND WELLNESS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-04",
        "last_updated": "2020-04-23",
        "certification_date": "2020-04-23",
        "status": "A",
        "authorized_official_last_name": "HOLLIDAY",
        "authorized_official_first_name": "BILLIE",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "480-474-5586"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "AZ",
            "license": "BH 3828",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "OTC-5116",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "OCT 6220",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Apache Junction, AZ

Sources for this page

Verify at the official NPI Registry.