Healthcare Provider Details

I. General information

NPI: 1417470667
Provider Name (Legal Business Name): VALLEY SPIRIT COOPERATIVE AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 GREEN HILL RD
WASHINGTON DEPOT CT
06793-1201
US

IV. Provider business mailing address

6 GREEN HILL RD
WASHINGTON DEPOT CT
06793-1201
US

V. Phone/Fax

Practice location:
  • Phone: 860-619-2788
  • Fax:
Mailing address:
  • Phone: 860-619-2788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KRISTIN KUNHARDT
Title or Position: VISON KEEPER / CEO
Credential:
Phone: 860-619-2788