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General NPI Number Information
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NPI Number | 1487130605
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Entity Type | Organization
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Legal Business Name | BLUE HERON HEALTH LLC
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Dates
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Enumeration Date | 07/11/2018
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Last Update Date | 07/11/2018
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Provider Practice Location Address
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Address Line | 82A MEADOW ST
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City | LITCHFIELD
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State | CT
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Zip | 06759-3543
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Country | US
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Telephone | 203-814-1455
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Fax | 203-264-2208
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Provider Business Mailing Address
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Address Line | 220 MAIN ST S STE 205
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City | SOUTHBURY
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State | CT
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Zip | 06488-2275
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Country | US
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Telephone | 203-814-1455
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Fax | 203-264-2208
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALICE P BELL
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Credential | ND
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Telephone | 203-873-8050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 000376
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License Number State | CT
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