Provider Demographics
NPI:1265704357
Name:RECOVERY AND HEALTH SOURCE LLC
Entity type:Organization
Organization Name:RECOVERY AND HEALTH SOURCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:W
Authorized Official - Last Name:MILKEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:203-305-5165
Mailing Address - Street 1:143 HOYT ST
Mailing Address - Street 2:4B
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5759
Mailing Address - Country:US
Mailing Address - Phone:203-918-8557
Mailing Address - Fax:203-517-9780
Practice Address - Street 1:143 HOYT ST
Practice Address - Street 2:4B
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5759
Practice Address - Country:US
Practice Address - Phone:203-918-8557
Practice Address - Fax:203-517-9780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004864363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty