MOGOLLON TREATMENT CENTER
NPI 1578482402
Substance Abuse Rehabilitation Facility in Phoenix, AZ

Q: What is Mogollon Treatment Center's NPI number?

The NPI number for Mogollon Treatment Center is 1578482402. It was assigned to this organization in the NPPES registry on July 14, 2026.

Q: What is Mogollon Treatment Center's specialty?

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

Active since July 14, 2026

9417 N 17TH PL, PHOENIX, AZ 85020(928) 466-4242(928) 474-7460 Get Directions Write a Review

NPPES record last updated: July 14, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

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About Mogollon Treatment Center NPPES

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

MOGOLLON TREATMENT CENTER (NPI 1578482402) is a healthcare organization registered as a substance abuse rehabilitation facility in Phoenix, Arizona and active in the NPI registry since July 2026. The organization lists Dustin Heracles Bullard, Owner, as its authorized official.

NPPES Registry Identity

NPI1578482402

Entity TypeOrganization

Primary Taxonomy324500000X

Legal Business NameMOGOLLON TREATMENT CENTER

Location Address9417 N 17TH PLPhoenix, AZ 85020-2310

Mailing Address306 W Aero DrPayson, AZ 85541-5405 · (928) 466-4242 · Fax (928) 474-7460

Phone(928) 466-4242

Fax(928) 474-7460

Organization SubpartNo

Authorized OfficialDustin Heracles BullardOwner · (928) 466-4242

Enumeration DateJuly 14, 2026

NPPES CertifiedJuly 14, 2026

✔ NPI 1578482402 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.

9417 N 17TH PL, Phoenix, AZ 85020

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Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ADVANCED BEHAVIORAL HEALTH SERVICES, LLC

Case Manager/Care Coordinator

9417 N 17TH PL
PHOENIX, AZ 85020

Maricopa County (520) 661-2594

ARIZONA ADDICTION TREATMENT LLC

Psychiatric Residential Treatment Facility

9417 N 17TH PL
PHOENIX, AZ 85020

Maricopa County (480) 227-5018

JOHN HARVEY DOHS

Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

9417 N 17TH PL
PHOENIX, AZ 85020

Maricopa County (520) 661-2594

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 1578482402. It was assigned to this organization in the NPPES registry on July 14, 2026.

Where is Mogollon Treatment Center located?

Mogollon Treatment Center is located at 9417 N 17th Pl, Phoenix, AZ 85020. 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.

When was this NPI record last updated?

The NPPES record for Mogollon Treatment Center was last updated on July 14, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.