Healthcare Provider Details

I. General information

NPI: 1780003020
Provider Name (Legal Business Name): CIRCLE OF LOVE , INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 08/03/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5522 NEW PEACHTREE RD STE 120-129
CHAMBLEE GA
30341-2543
US

IV. Provider business mailing address

5522 NEW PEACHTREE RD SUITE 129
CHAMBLEE GA
30341-2543
US

V. Phone/Fax

Practice location:
  • Phone: 770-454-7979
  • Fax: 770-217-4086
Mailing address:
  • Phone: 770-454-7979
  • Fax: 770-217-4086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number2014 NONPS-0077
License Number StateGA

VIII. Authorized Official

Name: WOOIYI YIN
Title or Position: DIRECTOR
Credential:
Phone: 770-612-1388