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General NPI Number Information
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NPI Number | 1245521970
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Entity Type | Organization
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Legal Business Name | COMMUNITY HEALTH & WELLNESS CENTER OF GREATER TORRINGTON
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Dates
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Enumeration Date | 04/28/2011
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Last Update Date | 04/28/2011
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Provider Practice Location Address
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Address Line | 469 MIGEON AVE
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City | TORRINGTON
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State | CT
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Zip | 06790-4643
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Country | US
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Telephone | 860-482-3038
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Fax | 860-482-3038
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Provider Business Mailing Address
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Address Line | 469 MIGEON AVE
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City | TORRINGTON
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State | CT
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Zip | 06790-4643
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Country | US
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Telephone | 860-482-3038
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Fax | 860-482-3038
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Authorized Official
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Title or Position | CEO
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Name | KATHLEEN GRIMAUD
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Credential | APRN
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Telephone | 860-482-3038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | PENDING
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License Number State | CT
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