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General NPI Number Information
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NPI Number | 1134538549
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Entity Type | Organization
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Legal Business Name | PEACE OF MIND BRAIN INJURY SERVICES INC
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Dates
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Enumeration Date | 08/11/2014
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Last Update Date | 08/11/2014
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Provider Practice Location Address
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Address Line | 47 FERRY RD
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City | CHESTER
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State | CT
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Zip | 06412-1232
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Country | US
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Telephone | 860-575-5489
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 247
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City | CHESTER
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State | CT
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Zip | 06412-0247
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | KARA GAGNON
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Credential |
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Telephone | 860-575-5489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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