Provider Demographics
NPI:1811399017
Name:HEALING EDGE
Entity Type:Organization
Organization Name:HEALING EDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-777-4555
Mailing Address - Street 1:13065 W MCDOWELL RD STE B111
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-6443
Mailing Address - Country:US
Mailing Address - Phone:623-777-4555
Mailing Address - Fax:623-242-5755
Practice Address - Street 1:13065 W MCDOWELL RD STE B111
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-6443
Practice Address - Country:US
Practice Address - Phone:623-777-4555
Practice Address - Fax:623-242-5755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ270171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty