Healthcare Provider Details

I. General information

NPI: 1982566584
Provider Name (Legal Business Name): CHOLLA BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5924 W HEDGEHOG PL
PHOENIX AZ
85083-6558
US

IV. Provider business mailing address

9201 N 25TH AVE STE 185
PHOENIX AZ
85021-2717
US

V. Phone/Fax

Practice location:
  • Phone: 602-686-5779
  • Fax:
Mailing address:
  • Phone: 602-686-5779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JERICHO CHEBULTZ
Title or Position: OWNER
Credential:
Phone: 602-686-5779