Healthcare Provider Details

I. General information

NPI: 1407230725
Provider Name (Legal Business Name): HOZHONI FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 N WALGREENS ST
FLAGSTAFF AZ
86004-6100
US

IV. Provider business mailing address

2133 N WALGREENS ST
FLAGSTAFF AZ
86004-6100
US

V. Phone/Fax

Practice location:
  • Phone: 928-526-7944
  • Fax: 928-526-5909
Mailing address:
  • Phone: 928-526-7944
  • Fax: 928-526-5909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateAZ

VIII. Authorized Official

Name: MONICA LANE ATTRIDGE
Title or Position: CEO
Credential:
Phone: 928-526-7944