Healthcare Provider Details

I. General information

NPI: 1760628549
Provider Name (Legal Business Name): CIRCLE OF LIFE HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2008
Last Update Date: 12/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W BEAR CREEK RD
GLENN HEIGHTS TX
75154-8701
US

IV. Provider business mailing address

801 W BEAR CREEK RD
GLENN HEIGHTS TX
75154-8701
US

V. Phone/Fax

Practice location:
  • Phone: 214-275-9645
  • Fax:
Mailing address:
  • Phone: 214-275-9645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateTX

VIII. Authorized Official

Name: MR. VICTOR PEREIRA
Title or Position: DIRECTOR
Credential:
Phone: 972-274-0012