Healthcare Provider Details

I. General information

NPI: 1619763729
Provider Name (Legal Business Name): CIRCLE THE CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3522 N 3RD AVE
PHOENIX AZ
85013-3903
US

IV. Provider business mailing address

300 W CLARENDON AVE STE 200
PHOENIX AZ
85013-3422
US

V. Phone/Fax

Practice location:
  • Phone: 602-776-0776
  • Fax: 602-776-3002
Mailing address:
  • Phone: 602-776-0776
  • Fax: 602-776-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: TERRELL COLEMAN
Title or Position: COMPLIANCE DIRECTOR
Credential:
Phone: 602-776-0776