NPIMap

Organization Active NPI

Mogollon Treatment Center

  • Substance Abuse Rehabilitation Facility
  • Phoenix, AZ
National Provider Identifier
1578482402
Registry record updated Jul 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
MOGOLLON TREATMENT CENTER
Practice address
9417 N 17TH PL
Phoenix, AZ 85020-2310
Phone
(928) 466-4242
Fax
(928) 474-7460
NPI assigned
Jul 14, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2026

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

Authorized official

Name
Dustin Heracles Bullard
Title
Owner
Phone
(928) 466-4242

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

9417 N 17TH PL
Phoenix, AZ 85020-2310

Mailing address

306 W Aero Dr
Payson, AZ 85541-5405
Phone (928) 466-4242

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.

NPI Registry JSON

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

{
    "created_epoch": "1783987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783987200000",
    "number": "1578482402",
    "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": "928-466-4242",
            "fax_number": "928-474-7460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9417 N 17TH PL",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850202310",
            "telephone_number": "928-466-4242",
            "fax_number": "928-474-7460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOGOLLON TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-07-14",
        "last_updated": "2026-07-14",
        "certification_date": "2026-07-14",
        "status": "A",
        "authorized_official_last_name": "BULLARD",
        "authorized_official_first_name": "DUSTIN",
        "authorized_official_middle_name": "HERACLES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-466-4242"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.