=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134762883
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARE CIRCLE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2019
-----------------------------------------------------
Last Update Date | 11/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1135 E ROUTE 66 STE 209
-----------------------------------------------------
City | GLENDORA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91740-3778
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-521-9051
-----------------------------------------------------
Fax | 626-466-3005
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1135 E ROUTE 66 STE 209
-----------------------------------------------------
City | GLENDORA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91740-3778
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-521-9051
-----------------------------------------------------
Fax | 626-466-3005
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BOARD SECRETARY
-----------------------------------------------------
Name | MRS. ANNA CERISSA REYES BASCO
-----------------------------------------------------
Credential | L.V.N.
-----------------------------------------------------
Telephone | 626-392-0359
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------