Healthcare Provider Details

I. General information

NPI: 1063205847
Provider Name (Legal Business Name): VALOR MOUNTAIN WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2025
Last Update Date: 05/26/2025
Certification Date: 05/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 E CONCHO ST
APACHE JUNCTION AZ
85119-9430
US

IV. Provider business mailing address

5850 E CONCHO ST
APACHE JUNCTION AZ
85119-9430
US

V. Phone/Fax

Practice location:
  • Phone: 425-320-6984
  • Fax:
Mailing address:
  • Phone: 425-320-6984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CHARITY WOOD
Title or Position: CEO
Credential:
Phone: 425-320-6984