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General NPI Number Information
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NPI Number | 1265704357
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Entity Type | Organization
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Legal Business Name | RECOVERY AND HEALTH SOURCE LLC
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Dates
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Enumeration Date | 02/03/2012
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Last Update Date | 02/03/2012
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Provider Practice Location Address
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Address Line | 143 HOYT ST 4B
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City | STAMFORD
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State | CT
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Zip | 06905-5759
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Country | US
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Telephone | 203-918-8557
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Fax | 203-517-9780
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Provider Business Mailing Address
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Address Line | 143 HOYT ST 4B
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City | STAMFORD
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State | CT
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Zip | 06905-5759
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Country | US
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Telephone | 203-918-8557
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Fax | 203-517-9780
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Authorized Official
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Title or Position | OWNER
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Name | CHARLENE W MILKEY
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Credential | APRN
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Telephone | 203-305-5165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 004864
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License Number State | CT
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