Healthcare Provider Details

I. General information

NPI: 1295800795
Provider Name (Legal Business Name): COMMUNITY HEALTH RESOURCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WATERSIDE XING STE 401
WINDSOR CT
06095-1588
US

IV. Provider business mailing address

2 WATERSIDE XING STE 401
WINDSOR CT
06095-1588
US

V. Phone/Fax

Practice location:
  • Phone: 860-731-5522
  • Fax: 860-731-5536
Mailing address:
  • Phone: 607-315-5228
  • Fax: 860-731-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License NumberSA-0102
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberSA0076,SA0128,SA0136
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberSA-0076,SA-0102
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberSA0076, SA0128,SA016
License Number StateCT

VIII. Authorized Official

Name: HEATHER M. GATES
Title or Position: PRESIDENT/CEO
Credential:
Phone: 860-731-5522