MEDICARE: CIRCLE OF LIGHT MENTAL HEALTH AND ADDICTION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3245S0500X	Children's Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1861325417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CIRCLE OF LIGHT MENTAL HEALTH AND ADDICTION LLC

Provider Business Mailing Address
First Line	:	2244 S HAMILTON RD STE 201C
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-4390
Country	:	US
Telephone Number	:	380-224-2056
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 MANOR DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-6438
Country	:	US
Telephone Number	:	614-604-6984
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	QIONA BENNETT
Credential	:
Telephone Number	:	614-397-7307

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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