Basic Information
Provider Information
NPI: 1215979810
EntityType: 2
ReplacementNPI:  
OrganizationName: COMMUNITY HEALTH RESOURCES, INC.
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Mailing Information
Address1: 2 WATERSIDE XING STE 401
Address2:  
City: WINDSOR
State: CT
PostalCode: 060951588
CountryCode: US
TelephoneNumber: 8607315522
FaxNumber: 8607315536
Practice Location
Address1: 2 WATERSIDE XING STE 401
Address2:  
City: WINDSOR
State: CT
PostalCode: 060951588
CountryCode: US
TelephoneNumber: 8607315522
FaxNumber: 8607315536
Other Information
ProviderEnumerationDate: 06/11/2006
LastUpdateDate: 10/01/2020
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: KENNEDY
AuthorizedOfficialFirstName: KIM
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AuthorizedOfficialTitleorPosition: EXECUTIVE ASSISTANT
AuthorizedOfficialTelephone: 8606973364
IsSoleProprietor:  
IsOrganizationSubpart: N
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NPICertificationDate: 10/01/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QM0855XOPCC-73CTN Ambulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
320800000X  N Residential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness 
261QM0801X  Y Ambulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)

ID Information
IDTypeStateIssuerDescription
00424965405CT MEDICAID


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