NPIMap

Organization Active NPI

Mogollon Treatment Center

Doing business as Paradise Valley Recovery

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Payson, AZ
National Provider Identifier
1245908763
Registry record updated Nov 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
MOGOLLON TREATMENT CENTER
Doing business as
Paradise Valley Recovery
Practice address
306 W Aero Dr
Payson, AZ 85541-5405
Phone
(714) 910-4286
NPI assigned
Aug 31, 2021
Last updated
Nov 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2023

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

Authorized official

Name
Mr. Tyri Norman BlondalNPI 1477316651
Title
Chief Operations Officer
Phone
(602) 516-2414

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

306 W Aero Dr
Payson, AZ 85541-5405

Mailing address

306 W Aero Dr
Payson, AZ 85541-5405
Phone (714) 910-4286

Other names 1

  • Paradise Valley Recovery Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL https://mogollontreatmentcenter.com/ Direct

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2302826Mogollon Treatment Center306 W Aero Dr, Payson, AZ 85541Certificate of waiverApr 15, 2028

National Provider Directory

National Provider Directory
Tax ID family
Mogollon Treatment Center6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 2

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": "1630368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698796800000",
    "number": "1245908763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 W AERO DR",
            "city": "PAYSON",
            "state": "AZ",
            "postal_code": "855415405",
            "telephone_number": "714-910-4286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 W AERO DR",
            "city": "PAYSON",
            "state": "AZ",
            "postal_code": "855415405",
            "telephone_number": "714-910-4286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOGOLLON TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-31",
        "last_updated": "2023-11-01",
        "certification_date": "2023-09-21",
        "status": "A",
        "authorized_official_last_name": "BLONDAL",
        "authorized_official_first_name": "TYRI",
        "authorized_official_middle_name": "NORMAN",
        "authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
        "authorized_official_telephone_number": "602-516-2414",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://mogollontreatmentcenter.com/",
            "affiliation": "N",
            "endpointDescription": "URL",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "306 W Aero Dr",
            "city": "Payson",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "855415405",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Paradise Valley Recovery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Paradise Valley Recovery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Payson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.