Healthcare Provider Details

I. General information

NPI: 1770592719
Provider Name (Legal Business Name): CIRCLE OF FRIENDS OWINGS MILLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 EAST CHESTNUT HILL LANE
REISTERSTOWN MD
21136
US

IV. Provider business mailing address

11 EAST CHESTNUT HILL LANE
REISTERSTOWN MD
21136
US

V. Phone/Fax

Practice location:
  • Phone: 410-517-1828
  • Fax: 410-517-3551
Mailing address:
  • Phone: 410-517-1828
  • Fax: 410-517-3551

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: ELLEN VEZEL
Title or Position: PRESIDENT
Credential:
Phone: 410-517-1828