| Chocolate Peach Bonding Company | |
|
2520 W Pinyon Ave Grand Jct CO 81505-6913 | |
| (970) 424-2577 | |
| Not Available |
| Full Name | Chocolate Peach Bonding Company |
|---|---|
| Speciality | Counselor |
| Location | 2520 W Pinyon Ave, Grand Jct, Colorado |
| Authorized Official Name and Position | Jimmy L Bond (OWNER) |
| Authorized Official Contact | 9704242577 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chocolate Peach Bonding Company Po Box 4955 Grand Jct CO 81502-4955 Ph: (970) 424-2577 | Chocolate Peach Bonding Company 2520 W Pinyon Ave Grand Jct CO 81505-6913 Ph: (970) 424-2577 |
| NPI Number | 1366195380 |
|---|---|
| Provider Enumeration Date | 01/31/2022 |
| Last Update Date | 11/12/2024 |
| Certification Date | 11/12/2024 |
| Medicare PECOS PAC ID | 1355876491 |
|---|---|
| Medicare Enrollment ID | O20241126000829 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366195380 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Jimmy Layne Bond |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720532146 PECOS PAC ID: 3678924123 Enrollment ID: I20240109001856 |
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