=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043605215
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CIRCLE OF LOVE HOME HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2015
-----------------------------------------------------
Last Update Date | 04/08/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3189 KIRBY WHITTEN RD 203D
-----------------------------------------------------
City | BARTLETT
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38134-2854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-266-1556
-----------------------------------------------------
Fax | 901-266-1557
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3189 KIRBY WHITTEN RD 203D
-----------------------------------------------------
City | BARTLETT
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38134-2854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-266-1556
-----------------------------------------------------
Fax | 901-266-1557
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ADMINISTRATOR
-----------------------------------------------------
Name | MRS. ANGELA WARREN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 901-438-6469
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | I000000015941
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------