MEDICARE: CONCRETE ROSE HEALING COLLECTIVE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1538001607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCRETE ROSE HEALING COLLECTIVE LLC

Provider Business Mailing Address
First Line	:	1245 FARMINGTON AVE
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06107-2667
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1245 FARMINGTON AVE
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06107-2667
Country	:	US
Telephone Number	:	860-919-3201
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	SASHAUNA BROWN
Credential	:	APRN
Telephone Number	:	860-919-3201

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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