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General NPI Number Information
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NPI Number | 1245631381
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Entity Type | Organization
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Legal Business Name | CIRCLE OF FRIENDS HOME CARE
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Dates
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Enumeration Date | 09/08/2014
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Last Update Date | 09/08/2014
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Provider Practice Location Address
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Address Line | 42 S ASHLAND AVE
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City | LA GRANGE
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State | IL
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Zip | 60525-6346
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Country | US
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Telephone | 630-417-8216
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Fax |
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Provider Business Mailing Address
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Address Line | 42 S ASHLAND AVE
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City | LA GRANGE
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State | IL
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Zip | 60525-6346
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Country | US
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Telephone | 630-417-8216
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CHARMAINE CYZA
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Credential | M.S.W.
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Telephone | 630-417-8216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 3000518
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License Number State | IL
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