Provider Demographics
NPI:1790826147
Name:BOND ENTERPRISES INC
Entity Type:Organization
Organization Name:BOND ENTERPRISES INC
Other - Org Name:WILLOWBROOK CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-236-7790
Mailing Address - Street 1:3720 AVE A
Mailing Address - Street 2:SUITE C
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847
Mailing Address - Country:US
Mailing Address - Phone:308-236-7790
Mailing Address - Fax:308-236-7790
Practice Address - Street 1:3720 AVE A
Practice Address - Street 2:SUITE C
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847
Practice Address - Country:US
Practice Address - Phone:308-236-7790
Practice Address - Fax:308-236-7790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========26Medicaid
NE=========26Medicaid