Healthcare Provider Details

I. General information

NPI: 1588777460
Provider Name (Legal Business Name): CIRCLES OF CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
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:
Mailing address:
  • Phone: 321-722-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number3987
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number8550
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number8599
License Number StateFL

VIII. Authorized Official

Name: FALLON DEROSA
Title or Position: HR MANAGER
Credential:
Phone: 321-722-5273