Healthcare Provider Details

I. General information

NPI: 1154521987
Provider Name (Legal Business Name): FRIENDSHIP CIRCLE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 COUNTRY CLUB RD
AVON CT
06001-2508
US

IV. Provider business mailing address

280 COUNTRY CLUB RD
AVON CT
06001-2508
US

V. Phone/Fax

Practice location:
  • Phone: 860-673-7631
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SALLY SOUTHERLAND
Title or Position: DIRECTOR
Credential:
Phone: 860-673-7631