NPIMap

Organization Active NPI

Mogollon Treatment Center

  • Substance Abuse Rehabilitation Facility
  • Phoenix, AZ
National Provider Identifier
1750160511
Registry record updated Sep 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
MOGOLLON TREATMENT CENTER
Practice address
5402 E Thomas Rd
Phoenix, AZ 85018-8107
Phone
(602) 516-2414
NPI assigned
Sep 21, 2023
Organization subpart
Yes
Parent organization
MOGOLLON TREATMENT CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 21, 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 connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

5402 E Thomas Rd
Phoenix, AZ 85018-8107

Mailing address

306 W Aero Dr
Payson, AZ 85541-5405
Phone (602) 516-2414

Other names 1

  • Paradise Valley Recovery Doing business as

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
03D2285971Mogollon Treatment Center5402 E Thomas Rd, Phoenix, AZ 85018Certificate of waiverJul 19, 2027

National Provider Directory

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

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1695254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695254400000",
    "number": "1750160511",
    "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": "602-516-2414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5402 E THOMAS RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850188107",
            "telephone_number": "602-516-2414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOGOLLON TREATMENT CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOGOLLON TREATMENT CENTER",
        "enumeration_date": "2023-09-21",
        "last_updated": "2023-09-21",
        "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": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Paradise Valley Recovery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 21, 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.