Healthcare Provider Details

I. General information

NPI: 1063816445
Provider Name (Legal Business Name): CIRCLE OF LOVE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9105 ALANBROOKE CT
FORT WORTH TX
76140-5167
US

IV. Provider business mailing address

9105 ALANBROOKE CT
FORT WORTH TX
76140-5167
US

V. Phone/Fax

Practice location:
  • Phone: 682-203-5975
  • Fax:
Mailing address:
  • Phone: 682-203-5975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: REGINA GUY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 682-203-5975