Provider Demographics
NPI:1730545609
Name:LOVE BOND COMMUNITY OUTREACH
Entity type:Organization
Organization Name:LOVE BOND COMMUNITY OUTREACH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:TRAMMELL
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-339-0333
Mailing Address - Street 1:9101 LYNDON B JOHNSON FWY STE 600
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-2055
Mailing Address - Country:US
Mailing Address - Phone:469-709-8977
Mailing Address - Fax:469-779-7003
Practice Address - Street 1:9101 LYNDON B JOHNSON FWY STE 600
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-2055
Practice Address - Country:US
Practice Address - Phone:469-709-8977
Practice Address - Fax:469-779-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-07
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX251B00000XMedicaid
TX193400000XMedicaid