Healthcare Provider Details

I. General information

NPI: 1932826237
Provider Name (Legal Business Name): CIRCLETREE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2914 NW ESSEX AVE
ALBANY OR
97321-9231
US

IV. Provider business mailing address

2914 NW ESSEX AVE
ALBANY OR
97321-9231
US

V. Phone/Fax

Practice location:
  • Phone: 541-331-2996
  • Fax:
Mailing address:
  • Phone: 541-331-2996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAMZID SARDAR
Title or Position: ADMIN/MGMT
Credential:
Phone: 541-331-2996