Healthcare Provider Details

I. General information

NPI: 1801920111
Provider Name (Legal Business Name): CIRCLE OF LIFE HOME CARE ANISHINAABE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 LEXINGTON AVE N STE 150
SHOREVIEW MN
55126-3025
US

IV. Provider business mailing address

4100 LEXINGTON AVE N STE 150
SHOREVIEW MN
55126-3025
US

V. Phone/Fax

Practice location:
  • Phone: 612-871-2474
  • Fax: 612-870-3874
Mailing address:
  • Phone: 612-871-2474
  • Fax: 612-870-3874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number03-091399-00-3
License Number StateNM

VIII. Authorized Official

Name: KATIE FLEURY
Title or Position: CEO
Credential:
Phone: 612-871-2474