Provider Demographics
NPI:1700233921
Name:CHS LIFE LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:CHS LIFE LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:COVELLO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:203-772-9224
Mailing Address - Street 1:PO BOX 1192
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-7192
Mailing Address - Country:US
Mailing Address - Phone:203-772-9224
Mailing Address - Fax:
Practice Address - Street 1:35 OLD TAVERN RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3450
Practice Address - Country:US
Practice Address - Phone:203-693-3425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000212171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty