Provider Demographics
NPI:1417470667
Name:VALLEY SPIRIT COOPERATIVE AND WELLNESS CENTER
Entity Type:Organization
Organization Name:VALLEY SPIRIT COOPERATIVE AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VISON KEEPER / CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-619-2788
Mailing Address - Street 1:6 GREEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON DEPOT
Mailing Address - State:CT
Mailing Address - Zip Code:06793-1201
Mailing Address - Country:US
Mailing Address - Phone:860-619-2788
Mailing Address - Fax:
Practice Address - Street 1:6 GREEN HILL RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON DEPOT
Practice Address - State:CT
Practice Address - Zip Code:06793-1201
Practice Address - Country:US
Practice Address - Phone:860-619-2788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service