| NPI | 1073012597 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY HENDERSON-KJELLEN Owner 860-836-7553 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X (Licence: CT 002808) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: CT 002808) |
| Enumeration Date | 2018-02-10 |
| Last Update Date | 2018-02-10 |