Cholla Behavioral Health LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

CHOLLA BEHAVIORAL HEALTH LLC

Doing business as

Cholla Behavioral Health

Practice address

9201 N 25TH Ave Ste 185
Phoenix, AZ 85021-2717

Phone

(602) 686-5779

NPI assigned

Dec 19, 2022

Organization subpart

No

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

Authorized official

Name

Mr. Jericho Chebultz

Title

Ceo

Phone

(602) 686-5779

Specialties & licenses 2

Addresses

Other names 1

• Cholla Behavioral Health Doing business as

Electronic endpoints 1

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

CLIA laboratory certificates

Tax ID family

Cholla Behavioral Health2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Cholla Behavioral Health LLC

  • Substance Abuse Rehabilitation Facility
  • Phoenix, AZ
  • NPI 1982566584
  NPD tax ID

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shannon Crawford-West, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Gilbert, AZ
  • NPI 1275164337
  NPD (past)
• Craig William Heise Jr., M.D.

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1629398912
  NPD (past)

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

{
    "created_epoch": "1671408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684972800000",
    "number": "1285346536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 W UNION HILLS DR UNIT 215",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850275816",
            "telephone_number": "602-686-5779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9201 N 25TH AVE STE 185",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850212717",
            "telephone_number": "602-686-5779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHOLLA BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-19",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-25",
        "status": "A",
        "authorized_official_last_name": "CHEBULTZ",
        "authorized_official_first_name": "JERICHO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-686-5779",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "EMR",
            "affiliation": "N",
            "endpointDescription": "Medical Record System",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2020 W Union Hills Dr Unit 215",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "850275816",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Cholla Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cholla Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Choices Network of Arizona, Inc.
• Choices Network of Arizona, Inc.
• Jennifer Choiniere, PHARMD
• Kathryn A Chojnacki, CPNP
• Chonnikarn Chokapirat, MD
• Cholla Behavioral Health LLC
• Cholla Medical Group, Inc
• Cholla Middle School
• Luke Chon, DPT
• Dorcas Jing Teng Chong, RDN

• Mental Health Clinic/Center (Including Community Mental Health Center) in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 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.