Provider Demographics
NPI:1417488362
Name:CHERRY BROOK HEALTH CARE CENTER
Entity Type:Organization
Organization Name:CHERRY BROOK HEALTH CARE CENTER
Other - Org Name:NEW HORIZON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON-KHOURI
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:860-219-9852
Mailing Address - Street 1:760 MATIANUCK AVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-3553
Mailing Address - Country:US
Mailing Address - Phone:860-219-9852
Mailing Address - Fax:
Practice Address - Street 1:760 MATIANUCK AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-3553
Practice Address - Country:US
Practice Address - Phone:860-219-9852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6975261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health