Provider Demographics
NPI:1295405900
Name:BONDING HEARTS
Entity Type:Organization
Organization Name:BONDING HEARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-263-3010
Mailing Address - Street 1:1616 E INDIAN SCHOOL RD STE 225
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-8613
Mailing Address - Country:US
Mailing Address - Phone:773-263-3010
Mailing Address - Fax:
Practice Address - Street 1:1616 E INDIAN SCHOOL RD STE 225
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-8613
Practice Address - Country:US
Practice Address - Phone:773-263-3010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health