Provider Demographics
NPI:1295458388
Name:HEALING EDGE NW
Entity type:Organization
Organization Name:HEALING EDGE NW
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:LAC
Authorized Official - Phone:623-777-4555
Mailing Address - Street 1:8617 W UNION HILLS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-7001
Mailing Address - Country:US
Mailing Address - Phone:623-977-2304
Mailing Address - Fax:623-242-5755
Practice Address - Street 1:8617 W UNION HILLS DR STE 100
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-7001
Practice Address - Country:US
Practice Address - Phone:623-977-2304
Practice Address - Fax:623-242-5755
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALING EDGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service