Healthcare Provider Details

I. General information

NPI: 1679541031
Provider Name (Legal Business Name): CIRCLES OF CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E SHERIDAN RD
MELBOURNE FL
32901-3184
US

IV. Provider business mailing address

400 E SHERIDAN RD
MELBOURNE FL
32901-3184
US

V. Phone/Fax

Practice location:
  • Phone: 321-722-5200
  • Fax: 321-722-5230
Mailing address:
  • Phone: 321-722-5200
  • Fax: 321-722-5230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number8550
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number8599
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: FALLON DEROSA
Title or Position: VICE PRESIDENT HUMAN RELATIONS
Credential:
Phone: 321-722-5273