Healthcare Provider Details

I. General information

NPI: 1003667510
Provider Name (Legal Business Name): CRK WELLNESS SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 RYDERS LN STE 101
STRATFORD CT
06614-1666
US

IV. Provider business mailing address

88 RYDERS LN STE 101
STRATFORD CT
06614-1666
US

V. Phone/Fax

Practice location:
  • Phone: 203-375-1101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA KONOPKA
Title or Position: OWNER
Credential:
Phone: 203-375-1101