Healthcare Provider Details

I. General information

NPI: 1831596535
Provider Name (Legal Business Name): CIRCLE OF LOVE FAMILY CARE HOME LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6604 HWY 264 EAST ALT.
STANTONSBURG NC
27883-9203
US

IV. Provider business mailing address

6604 HWY 264 EAST ALT.
STANTONSBURG NC
27883-9203
US

V. Phone/Fax

Practice location:
  • Phone: 252-238-8054
  • Fax: 252-238-8054
Mailing address:
  • Phone: 252-238-8054
  • Fax: 252-238-8054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. JOYCE RENEE ADAMS
Title or Position: CEO/ADMINISTRATOR/OWNER
Credential:
Phone: 252-238-8054