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General NPI Number Information
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NPI Number | 1417488362
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Entity Type | Organization
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Legal Business Name | CHERRY BROOK HEALTH CARE CENTER
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Dates
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Enumeration Date | 03/22/2017
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Last Update Date | 03/22/2017
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Provider Practice Location Address
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Address Line | 760 MATIANUCK AVE
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City | WINDSOR
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State | CT
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Zip | 06095-3553
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Country | US
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Telephone | 860-219-9852
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Fax |
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Provider Business Mailing Address
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Address Line | 760 MATIANUCK AVE
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City | WINDSOR
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State | CT
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Zip | 06095-3553
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Country | US
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Telephone | 860-219-9852
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. VERONA GORDON-KHOURI
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Credential | FNP-BC
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Telephone | 860-219-9852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 6975
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License Number State | CT
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