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MOGOLLON TREATMENT CENTER
NPI 1063225233
Substance Abuse Rehabilitation Facility in Payson, AZ

Active since January 30, 2025CLIA Certified · 3 labs
212 W WADE LN, PAYSON, AZ 85541(928) 466-4242(928) 474-7460 Get Directions Write a Review

NPPES record last updated: January 30, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mogollon Treatment Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MOGOLLON TREATMENT CENTER (NPI 1063225233), doing business as Mogollon Residential, is a healthcare organization registered as a substance abuse rehabilitation facility in Payson, Arizona and active in the NPI registry since January 2025. The organization holds 3 active CLIA laboratory certificates and lists Tyri Norman Blondal, Coo, as its authorized official.

NPPES Registry Identity

NPI1063225233
Entity TypeOrganization
Primary Taxonomy324500000X
Legal Business NameMOGOLLON TREATMENT CENTER
Location Address212 W WADE LNPayson, AZ 85541-4852
Mailing Address306 W Aero DrPayson, AZ 85541-5405 · (602) 516-2414 · Fax (928) 474-7460
Phone(928) 466-4242
Fax(928) 474-7460
Organization SubpartYes
Authorized OfficialTyri Norman BlondalCoo · (602) 516-2414
Enumeration DateJanuary 30, 2025
NPPES CertifiedJanuary 30, 2025
✔ NPI 1063225233 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySubstance Abuse Rehabilitation FacilityResidential Treatment Facilities
Taxonomy Code324500000X
Definition
A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.
212 W WADE LN, Payson, AZ 85541
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Other Names 1

Doing Business AsMogollon Residential

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross Blue Shield of Arizona.Insurance ›

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 03D2302826

Mogollon Treatment Center · Payson, AZ
Active · expires Apr 15, 2028
CLIA Number03D2302826
Laboratory TypeSubaccute Detox Facility
Certificate Effective DateApril 16, 2026
Certificate Expiration DateApril 15, 2028
Laboratory DirectorTyri Blondal
Laboratory Phone(602) 516-2414
Laboratory LocationMogollon Treatment Center306 W Aero Dr, Payson, AZ 85541
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 03D2318161

Mogollon Treatment Center Dba (mogollon Residential) · Payson, AZ
Active · expires Feb 5, 2027
CLIA Number03D2318161
Laboratory TypeSubstance Abuse Residenti
Certificate Effective DateFebruary 6, 2025
Certificate Expiration DateFebruary 5, 2027
Laboratory DirectorTyri Blondal
Laboratory Phone(602) 516-2414
Laboratory LocationMogollon Treatment Center Dba (mogollon Residential)212 W Wade Ln, Payson, AZ 85541
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 03D2338949

Mogollon Treatment Center, LLC · Payson, AZ
Active · expires Feb 19, 2028
CLIA Number03D2338949
Laboratory TypeSubstance Abuse Residenti
Certificate Effective DateFebruary 20, 2026
Certificate Expiration DateFebruary 19, 2028
Laboratory DirectorRylie E. Perkes
Laboratory Phone(928) 474-7173
Laboratory LocationMogollon Treatment Center, LLC300 W Wade Ln, Payson, AZ 85541
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mogollon Treatment Center's NPI number?

The NPI number for Mogollon Treatment Center is 1063225233. It was assigned to this organization in the NPPES registry on January 30, 2025. The provider is doing business as Mogollon Residential.

Where is Mogollon Treatment Center located?

Mogollon Treatment Center is located at 212 W Wade Ln, Payson, AZ 85541. The listed phone number is (928) 466-4242.

What is Mogollon Treatment Center's specialty?

The primary specialty registered for this NPI is Substance Abuse Rehabilitation Facility with taxonomy code 324500000X.

Does Mogollon Treatment Center hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Mogollon Treatment Center accept?

Health plans from Blue Cross Blue Shield of Arizona list Mogollon Treatment Center as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Mogollon Treatment Center was last updated on January 30, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.