Provider Demographics
NPI:1336602788
Name:HEART TO HEART BEHAVIORAL HEALTH GROUP HOME, LLC
Entity Type:Organization
Organization Name:HEART TO HEART BEHAVIORAL HEALTH GROUP HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:USMAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUNDU
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN/PH
Authorized Official - Phone:480-977-9457
Mailing Address - Street 1:3555 N SAILBOAT LN
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-3620
Mailing Address - Country:US
Mailing Address - Phone:480-977-9457
Mailing Address - Fax:
Practice Address - Street 1:8535 W PALM LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3902
Practice Address - Country:US
Practice Address - Phone:480-977-9457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty