Healthcare Provider Details

I. General information

NPI: 1871991836
Provider Name (Legal Business Name): HORIZON HEALTH AND WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2014
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N PLAZA DR
APACHE JUNCTION AZ
85120-5501
US

IV. Provider business mailing address

625 N. PLAZA DRIVE
APACHE JUNCTION AZ
85120-5501
US

V. Phone/Fax

Practice location:
  • Phone: 480-983-0065
  • Fax: 480-288-5339
Mailing address:
  • Phone: 480-983-0065
  • Fax: 480-671-4541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License NumberOTC6220
License Number StateAZ

VIII. Authorized Official

Name: NORMAN E. MUDD
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MA, LMFT
Phone: 480-983-0065