Healthcare Provider Details

I. General information

NPI: 1043687775
Provider Name (Legal Business Name): HORIZON HEALTH AND WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W 2ND ST
CASA GRANDE AZ
85122-4406
US

IV. Provider business mailing address

625 N PLAZA DR
APACHE JUNCTION AZ
85120-5501
US

V. Phone/Fax

Practice location:
  • Phone: 520-836-3633
  • Fax:
Mailing address:
  • Phone: 480-983-0065
  • Fax: 480-671-4541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BILLIE HOLLIDAY
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 480-474-5586