| NPI | 1205462348 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE LOUISE BICKING CEO 860-650-1651 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 251S00000X |
| 251V00000X Voluntary or Charitable | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2020-03-20 |
| Last Update Date | 2020-09-23 |