Provider Demographics
NPI:1487957973
Name:THE CENTER FOR RECOVERY AND SPIRITUAL HEALING
Entity type:Organization
Organization Name:THE CENTER FOR RECOVERY AND SPIRITUAL HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:C
Authorized Official - Last Name:HENNESSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:203-379-6403
Mailing Address - Street 1:192 S MAIN ST
Mailing Address - Street 2:REAR ENTRANCE
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3727
Mailing Address - Country:US
Mailing Address - Phone:203-262-0403
Mailing Address - Fax:860-788-6777
Practice Address - Street 1:192 S MAIN ST
Practice Address - Street 2:REAR ENTRANCE
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3727
Practice Address - Country:US
Practice Address - Phone:203-262-0403
Practice Address - Fax:860-788-6777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000511251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health